NPIMap

Individual provider Active NPI

Philip J Fracica, M.D.

  • Pulmonary Disease Physician
  • Sedalia, MO
National Provider Identifier
1043320278
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
22761 Issued in AZ
Practice address
601 E 14TH St
Sedalia, MO 65301-5972
Phone
(660) 827-9488
NPI assigned
Aug 30, 2006
Last updated
Aug 3, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2008007036 MO
Pulmonary Disease Physician 207RP1001X 22761 AZ Primary

Addresses

Primary practice location

601 E 14TH St
Sedalia, MO 65301-5972

Mailing address

601 E 14TH St
PO Box 1706
Sedalia, MO 65301-5972
Phone (660) 827-9488

Other identifiers 1

IdentifierTypeStateIssuer
171843MedicaidAZ

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
I20160801000569 MO Practitioner - Internal Medicine 3274526660 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
22761AZMDSocial Worker
2008007036MOMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bothwell Regional Health Center Current Accepting new patients
Bothwell Regional Health Center CurrentSince Aug 1, 2016 Accepting new patients
Bothwell Regional Health Center CurrentSince Aug 1, 2016 Accepting new patients
Dignity Health Past Accepting new patients

Locations

601 E 14th St
Sedalia, MO 65301
Phone (660) 826-8833

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Bothwell Health Center-Truman LakeWarsaw, MO, CCN 268598 Rural health clinic Corporate Officer Nov 16, 2015
Bothwell TLC PediatricsSedalia, MO, CCN 268783 Rural health clinic Corporate Officer Nov 16, 2015
Cole Camp ClinicCole Camp, MO, CCN 268795 Rural health clinic Corporate Officer Nov 16, 2015

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 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659484800000",
    "number": "1043320278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E 14TH ST",
            "address_2": "PO BOX 1706",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653015972",
            "telephone_number": "660-827-9488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E 14TH ST",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653015972",
            "telephone_number": "660-827-9488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRACICA",
        "first_name": "PHILIP",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2008007036",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "AZ",
            "license": "22761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171843",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sedalia, MO

Sources for this page

Verify at the official NPI Registry.