Active NPI
Roy Jack Gillispie, MD
- Family Medicine Physician
- Branson, MO
National Provider Identifier
1023052115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R2A36
- Practice address
- 5136 Hwy 265
Branson, MO 65616-9099 - Phone
- (417) 338-0960
- Fax
- (417) 338-0968
- NPI assigned
- Jun 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R2A36 | MO | Primary |
Addresses
Primary practice location
5136 Hwy 265
Branson, MO 65616-9099
Mailing address
5136 Hwy 265
Branson, MO 65616-9099
Phone (417) 338-0960
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201260536 | Medicaid | MO | |
| 7500 | Other | BCBS | |
| 080192592 | Other | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R2A36 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Skaggs Community Hospital Association | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthopaedic Surgery Physician
- Branson, MO
- NPI 1871523357
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367366400000",
"number": "1023052115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5136 HWY 265",
"city": "BRANSON",
"state": "MO",
"postal_code": "656169099",
"telephone_number": "417-338-0960",
"fax_number": "417-338-0968"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5136 HWY 265",
"city": "BRANSON",
"state": "MO",
"postal_code": "656169099",
"telephone_number": "417-338-0960",
"fax_number": "417-338-0968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLISPIE",
"first_name": "ROY",
"middle_name": "JACK",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-16",
"last_updated": "2013-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "R2A36",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201260536",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "7500",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "080192592",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Branson, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.