NPIMap

Individual provider Active NPI

Bohdan A Lebedowicz, MD

  • Internal Medicine Physician
  • Rolla, MO
National Provider Identifier
1023087731
Registry record updated Sep 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01049329A Issued in IN
Practice address
1050 W 10TH St
Rolla, MO 65401-2905
Phone
(573) 364-9000
Fax
(573) 202-2484
NPI assigned
Mar 15, 2006
Last updated
Sep 9, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2010005856 MO
Internal Medicine Physician 207R00000X 01049329A IN Primary

Addresses

Primary practice location

1050 W 10TH St
Rolla, MO 65401-2905

Mailing address

1050 W 10TH St
Attn: Executive Director of Physician Clinics
Rolla, MO 65401-2905
Phone (573) 364-9000

Other practice location 1

1000 W 10th St
Rolla, MO 65401-2905
Phone (573) 458-8899

Other practice location 2

1000 W 10th St
Rolla, MO 65401-2905
Phone (573) 364-9000

Other identifiers 2

IdentifierTypeStateIssuer
00000183115OtherINBLUE CROSS
200191400MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101220000159 MO Practitioner - Internal Medicine 5294794186 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pcrmc Medical Group IncGroup PAC ID 1557454063, 113 clinicians
Mineral Area Psychiatric Services LLCGroup PAC ID 3072880962, 10 clinicians

Practice addresses (Care Compare)

1000 W 10TH St
Rolla, MO 65401-2905
Phone (573) 364-9000

1050 W 10TH St
Rolla, MO 65401-2905
Phone (573) 364-9000

1060 W 10TH St
Rolla, MO 65401-2905
Phone (855) 406-3324

203 S Washington St
Farmington, MO 63640-1836
Phone (573) 330-6468

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01049329AINMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pcrmc Medical Group, Inc Internal Medicine CurrentSince Jan 3, 2011 Accepting new patients
Mineral Area Psychiatric Services LLC CurrentSince Aug 18, 2025 Accepting new patients
Phelps County Regional Medical Center CurrentSince Jan 3, 2011 Accepting new patients
Phelps County Regional Medical Center CurrentSince Jun 13, 2023 Accepting new patients
Silverstone SNF LLC Past Accepting new patients
Elm Investment Group LLC Past Accepting new patients
N & R of St James LLC Past Accepting new patients
Major Hospital Past Accepting new patients
Vienna Nursing & Rehab LLC Past Accepting new patients
Bel Oak of Meramec LLC Past Accepting new patients
Midwest Internal Medicine PC Internal Medicine Past Accepting new patients
Redbud Investment Group LLC Past Accepting new patients
Waynesville Medical Investors, LLC Past Accepting new patients
Cuba Manor, Inc. Past Accepting new patients
Fayette Memorial Hospital Association Inc. Past Accepting new patients
Crossroads Physicians Corp Internal Medicine Past Accepting new patients
Presbyterian Manors, Inc. Past Accepting new patients
N & R of Dixon, LLC Past Accepting new patients
Dixon Manor, LLC PastSince May 1, 2025 Accepting new patients
Ozarks Medical Center Past Accepting new patients
Presbyterian Manors, Inc. Past Accepting new patients
N & R of Lebanon North LLC Past Accepting new patients
Rolla Grand LLC Past Accepting new patients
Eldercare of Mid-Missouri Xiv Inc. Past Accepting new patients
Licking No 1 LLC Past Accepting new patients
Georgian Gardens Healthcare LLC Past Accepting new patients

Locations

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

1050 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

35625 Highway 72
Salem, MO 65560
Phone (417) 425-3062

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Life Care Center of WaynesvilleWaynesville, MO, CCN 265373 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 1, 2023
Mar 3, 2025
Dixon Rehab & HCCDixon, IL, CCN 145906 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 1, 2025
May 1, 2025
Silverstone PlaceRolla, MO, CCN 265851 Skilled nursing facility Contracted Managing Employee
Adp of the SNF		 Jan 1, 2016
Jan 8, 2025
Steelville Senior LivingSteelville, MO, CCN 265866 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 1, 2025
Dec 12, 2025

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 26

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 26

Hospital & facility affiliations 20

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757376000000",
    "number": "1023087731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W 10TH ST",
            "address_2": "ATTN: EXECUTIVE DIRECTOR OF PHYSICIAN CLINICS",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "573-364-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 W 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "573-364-9000",
            "fax_number": "573-202-2484"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654012905",
            "country_code": "US",
            "telephone_number": "573-458-8899",
            "fax_number": "573-341-5611",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654012905",
            "country_code": "US",
            "telephone_number": "573-364-9000",
            "fax_number": "573-426-2108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEBEDOWICZ",
        "first_name": "BOHDAN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-15",
        "last_updated": "2025-09-09",
        "certification_date": "2025-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2010005856",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01049329A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "00000183115",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200191400",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rolla, MO

Sources for this page

Verify at the official NPI Registry.