Individual provider Active NPI

Cephas Paniamogan, FNP-C

  • Family Nurse Practitioner
  • Bethany, MO
National Provider Identifier
1053601716
Registry record updated Jun 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2011007027 Issued in MO
Practice address
3202 Miller St
Bethany, MO 64424-2713
Phone
(660) 425-3154
NPI assigned
Apr 15, 2011
Last updated
Jun 24, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2011007027 MO Primary

Addresses

Primary practice location

3202 Miller St
Bethany, MO 64424-2713

Mailing address

16027 Locust St
Apt 5
Eagleville, MO 64442-7130
Phone (660) 867-5111

Other practice location 1

16027 Locust St
Eagleville, MO 64442-7130
Phone (660) 867-5111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120626000664 MO Practitioner - Nurse Practitioner 8022273994 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

16027 Locust St
Eagleville, MO 64442-7130
Phone (660) 867-5111

3202 Miller St
Bethany, MO 64424-2713
Phone (660) 425-3154

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2011007027MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Harrison County Community Hospital District CurrentSince Oct 27, 2012 Accepting new patients
Harrison County Community Hospital District Current Accepting new patients
Harrison County Community Hospital District CurrentSince Oct 27, 2012 Accepting new patients
Harrison County Community Hospital District Past Accepting new patients

Locations

2600 Miller St
Bethany, MO 64424
Phone (660) 425-2211

3202 Miller St
Bethany, MO 64424
Phone (660) 425-3154

16027 Locust St
Eagleville, MO 64442
Phone (660) 425-0201

16027 Locust St
Apt 5
Eagleville, MO 64442

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.

Hospital & facility affiliations 1

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": "1302825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782259200000",
    "number": "1053601716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16027 LOCUST ST",
            "address_2": "APT 5",
            "city": "EAGLEVILLE",
            "state": "MO",
            "postal_code": "644427130",
            "telephone_number": "660-867-5111",
            "fax_number": "660-425-2366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3202 MILLER ST",
            "city": "BETHANY",
            "state": "MO",
            "postal_code": "644242713",
            "telephone_number": "660-425-3154"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16027 Locust St",
            "address_purpose": "LOCATION",
            "city": "Eagleville",
            "state": "MO",
            "postal_code": "644427130",
            "country_code": "US",
            "telephone_number": "660-867-5111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PANIAMOGAN",
        "first_name": "CEPHAS",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-15",
        "last_updated": "2026-06-24",
        "certification_date": "2026-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2011007027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethany, MO

Sources for this page

Verify at the official NPI Registry.