SPS Practice Group, LLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

SPS PRACTICE GROUP, LLC

Practice address

3220 Bluff Creek Dr
Columbia, MO 65201-3663

Phone

(573) 690-6129

NPI assigned

Jul 17, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Leslie Shock, MD

Title

Owner

Phone

(573) 224-8200

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Misha Anne Summerhays, PA-C

  • Physician Assistant
  • Jefferson City, MO
  • NPI 1780968701
  NPD

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

{
    "created_epoch": "1658016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692057600000",
    "number": "1053046888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3220 BLUFF CREEK DR STE 107",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652013664",
            "telephone_number": "573-224-8200",
            "fax_number": "573-224-8026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 BLUFF CREEK DR",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652013663",
            "telephone_number": "573-690-6129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPS PRACTICE GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-17",
        "last_updated": "2023-08-15",
        "certification_date": "2023-01-05",
        "status": "A",
        "authorized_official_last_name": "SHOCK",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-224-8200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1053046888",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Joseph Sporleder, DO
• Sport and Spine Rehab
• Tracy Sprague
• Ginger Spratt, RRT
• Lori A. Spry, MSW, LCSW
• Alexandria Spurgeon, MD
• Alisha Squires
• Austin Squires, MD
• Devin Squires, FNP
• Kelley N Squires, MD

• Plastic Surgery Physician in Columbia, MO
• Providers in Columbia, MO by specialty
• Plastic Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.