Active NPI
Wade Sutter
- Professional Counselor
- Hannibal, MO
National Provider Identifier
1063103869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2023015724
- Practice address
- 1221 Broadway
Hannibal, MO 63401-4005 - Phone
- (573) 221-2111
- NPI assigned
- May 15, 2023
- Last updated
- Jan 29, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2023015724 | MO | Primary |
Addresses
Primary practice location
1221 Broadway
Hannibal, MO 63401-4005
Mailing address
115 W Lafayette St
Palmyra, MO 63461-1525
Phone (573) 629-8983
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
154 Forrest Dr
Hannibal, MO 63401-5511
Phone (573) 221-2120
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2023015724 | MO | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| White Oak Counseling, LLC | Current | Accepting new patients |
Locations
1221 Broadway
Hannibal, MO 63401
Phone (573) 221-2111
Organizations & group practices 2
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.
-
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- Community/Behavioral Health Agency
- Hannibal, MO
- NPI 1700933363
-
- Clinical Social Worker
- Hannibal, MO
- NPI 1750586103
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706486400000",
"number": "1063103869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 W LAFAYETTE ST",
"city": "PALMYRA",
"state": "MO",
"postal_code": "634611525",
"telephone_number": "573-629-8983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1221 BROADWAY",
"city": "HANNIBAL",
"state": "MO",
"postal_code": "634014005",
"telephone_number": "573-221-2111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUTTER",
"first_name": "WADE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-15",
"last_updated": "2024-01-29",
"certification_date": "2024-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2023015724",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hannibal, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.