NPIMap

Individual provider Active NPI

Jeffrey Paul Tindall, DO

  • Family Medicine Physician
  • Potosi, MO
National Provider Identifier
1043281694
Registry record updated Jun 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12079 Issued in MO
Practice address
200 Health Way Dr
Potosi, MO 63664-1434
Phone
(573) 438-3655
Fax
(573) 438-3105
NPI assigned
Jan 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 12079 MO Primary

Addresses

Primary practice location

200 Health Way Dr
Potosi, MO 63664-1434

Mailing address

300 Health Way Dr
Potosi, MO 63664-1420
Phone (573) 438-3655

Other identifiers 1

IdentifierTypeStateIssuer
208364208MedicaidMO

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
I20040903000036 MO Practitioner - Family Practice 7315913175 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Pikeville, Kentucky College of Osteopathic Med, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington County Memorial HospitalGroup PAC ID 3476456880, shared by 6 NPIs, 22 clinicians

Practice addresses (Care Compare)

1200 N One Mile Rd
Southeast Health Center of Stoddard
Dexter, MO 63841-1000
Phone (573) 614-1900

200 Health Way Dr
Healthway Primary Care
Potosi, MO 63664-1434
Phone 5734385451355

300 Health Way
Potosi, MO 63664-1420

300 Health Way Dr
Potosi, MO 63664-1420
Phone 5734385451355

612 E High St
Potosi, MO 63664-1429

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
70.1 of 100Reported as group
Quality
41.46
Improvement activities
40
Cost
87.48

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12079MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Health Solutions LLC Current Accepting new patients
Southeast Health Center of Stoddard County, LLC Family Medicine Current Accepting new patients
Southeast Health Center of Stoddard County, LLC Family Medicine CurrentSince Jan 24, 2023 Accepting new patients
Southeast Health Center of Stoddard County LLC Family Medicine CurrentSince Jan 24, 2023 Accepting new patients
Midwest Imaging Center II, LLC Past Accepting new patients
Washington County Memorial Hospital Past Accepting new patients
Southeast Health Center of Stoddard County, LLC Past Accepting new patients

Locations

1200 N One Mile Rd
Dexter, MO 63841
Phone (573) 614-1900

24 Southtowne Dr
Potosi, MO 63664
Phone (573) 436-4336

Interoperability endpoints

  • Direct secure messaging: jeffrey.tindall.p1@direct.wcmh-clinics.nextgenshare.com

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Midwest Rural Convenient CarePotosi, MO, CCN 793836 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Corporate Officer (100%)
Operational/Managerial Control (100%)		 Jun 15, 2015
Jun 15, 2015
Jun 15, 2015

Owned or controlled facilities with NPI records 1

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

Organizations & group practices 8

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402963200000",
    "number": "1043281694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 HEALTH WAY DR",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636641420",
            "telephone_number": "573-438-3655",
            "fax_number": "573-438-3105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HEALTH WAY DR",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636641434",
            "telephone_number": "573-438-3655",
            "fax_number": "573-438-3105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TINDALL",
        "first_name": "JEFFREY",
        "middle_name": "PAUL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-31",
        "last_updated": "2014-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "12079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208364208",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Potosi, MO

Sources for this page

Verify at the official NPI Registry.