Jerry Joseph Bruggeman, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2004011867 Issued in MO

Practice address

910 N College Ave Ste 4
Columbia, MO 65201-4797

Phone

(636) 642-1215

Fax

(573) 234-4799

NPI assigned

May 17, 2006

Last updated

Dec 20, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

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.

• Moberly Hospital Company LLC

  dba Chariton Valley Family Medicine

  • Rural Health Clinic/Center
  • Salisbury, MO
  • NPI 1851713580
  NPD (past)
• Moberly Medical Clinics Inc

  dba Moberly Diagnostics

  • Radiology Clinic/Center
  • Moberly, MO
  • NPI 1003226010
  NPD (past)
• Moberly Medical Clinics Inc

  • Multi-Specialty Clinic/Center
  • Moberly, MO
  • NPI 1336135607
  NPD (past)
• Physician Groups LC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1285664268

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1033161120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 N COLLEGE AVE STE 4",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652014797",
            "telephone_number": "636-642-1215",
            "fax_number": "573-234-4799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 N COLLEGE AVE STE 4",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652014797",
            "telephone_number": "636-642-1215",
            "fax_number": "573-234-4799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUGGEMAN",
        "first_name": "JERRY",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2004011867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207251901",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Martha Brownlee-Duffeck, PH.D.
• Callyn Broyles
• Bruce E Ringdahl LLC
• Janie Leathers Bruce, MD
• Tia Bruce, PNP
• David P. Brummett, M.D.
• Madison Paige Brune
• Abby Marie Brunnert, NP-C
• Erica Christine Bruns, PLPC
• Kyle Louis Bruns, DO

• Family Medicine Physician in Columbia, MO
• Providers in Columbia, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.