NPIMap

Organization Active NPI

Bothwell Regional Health Center

Doing business as Bothwell Sleep Disorders Center

  • Sleep Medicine (Internal Medicine) Physician
  • Warsaw, MO
National Provider Identifier
1043401284
Registry record updated Mar 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0012X
Legal business name
BOTHWELL REGIONAL HEALTH CENTER
Doing business as
Bothwell Sleep Disorders Center
Practice address
110 Tower Dr
Sutie B
Warsaw, MO 65355
Phone
(660) 438-0012
NPI assigned
Aug 5, 2007
Last updated
Mar 29, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
BOTHWELL REGIONAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 29, 2014

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

Authorized official

Name
James A Robertson
Title
Cfo
Phone
(660) 827-9482

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Internal Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RS0012X Primary

Addresses

Primary practice location

110 Tower Dr
Sutie B
Warsaw, MO 65355

Mailing address

PO Box 1706
601 E 14TH Street
Sedalia, MO 65302-1706
Phone (660) 826-8833

Other identifiers 1

IdentifierTypeStateIssuer
509328902MedicaidMO

Other names 1

  • Bothwell Sleep Disorders Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310000246 MO Part B Supplier - Clinic/Group Practice 6103714126 Receives reassigned benefits from 206 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Warsaw, MO; Sedalia, MO; Lincoln, MO; Cole Camp, MO

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Bothwell Regional Healt

Locations

110 Tower Dr
Ste B
Warsaw, MO 65355
Phone (660) 438-0000

NPI Registry JSON

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396051200000",
    "number": "1043401284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1706",
            "address_2": "601 E 14TH STREET",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653021706",
            "telephone_number": "660-826-8833",
            "fax_number": "660-827-3742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 TOWER DR",
            "address_2": "SUTIE B",
            "city": "WARSAW",
            "state": "MO",
            "postal_code": "65355",
            "telephone_number": "660-438-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOTHWELL REGIONAL HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOTHWELL REGIONAL HEALTH CENTER",
        "enumeration_date": "2007-08-05",
        "last_updated": "2014-03-29",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "660-827-9482"
    },
    "taxonomies": [
        {
            "code": "207RS0012X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "509328902",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bothwell Sleep Disorders Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warsaw, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.