NPIMap

Individual provider Active NPI

Michael Peter Dudenhoeffer, DO

  • Family Medicine Physician
  • Jefferson City, MO
National Provider Identifier
1073517900
Registry record updated Apr 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R1F18 Issued in MO
Practice address
606 E High St
Jefferson City, MO 65101-3279
Phone
(573) 635-2211
Fax
(573) 636-9350
NPI assigned
Jun 9, 2005
Last updated
Apr 24, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R1F18 MO Primary

Addresses

Primary practice location

606 E High St
Jefferson City, MO 65101-3279

Mailing address

606 E High St
Jefferson City, MO 65101-3279
Phone (573) 635-2211

Other identifiers 1

IdentifierTypeStateIssuer
242735520MedicaidMO

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
I20100603000902 MO Practitioner - Family Practice 3072513308 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1125 Madison St
Jefferson City, MO 65101-5227
Phone (573) 632-5000

1899 Hwy 63
Westphalia, MO 65085-2358
Phone (573) 455-2280

445 2ND St
Argyle, MO 65001-2236
Phone (573) 728-6275

606 E High St
Jefferson City, MO 65101-3279
Phone (573) 635-2211

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
22.53 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
75.11

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Vienna Nursing & Rehab LLC Past Accepting new patients
Eldercare of Mid-Missouri VI Inc. Past Accepting new patients
Mokane No 1 Inc Past Accepting new patients
Curators of the University of Missouri Past Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Riverview Nursing CenterMokane, MO, CCN 265434 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Nov 1, 2023
Nov 1, 2023
Stonebridge WestphaliaWestphalia, MO, CCN 265777 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 1, 2014
May 1, 2014

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208995200000",
    "number": "1073517900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 E HIGH ST",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651013279",
            "telephone_number": "573-635-2211",
            "fax_number": "573-636-9350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 E HIGH ST",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651013279",
            "telephone_number": "573-635-2211",
            "fax_number": "573-636-9350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDENHOEFFER",
        "first_name": "MICHAEL",
        "middle_name": "PETER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2008-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R1F18",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "242735520",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson City, MO

Sources for this page

Verify at the official NPI Registry.