Patrick Edward Macmillan, D.O.
Individual provider Active NPI Family Medicine Physician · Rogersville, MO
NPI 1073604690 · NPPES record last updated Aug 17, 2022
Key facts
- NPI
- 1073604690
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- R2H29 (MO)
- Practice address
- 101 S Main St
Rogersville, MO 65742-9357 - Phone
- (417) 753-9404
- Fax
- (417) 753-9137
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 18
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- At Still University of Health Sciences, College of Osteo Med, Kirksville, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sgoh Acquisition Inc
Practice addresses (Care Compare)
101 S Main St
Rogersville, MO 65742-9357
Phone (417) 753-9404
106 S Hickory St
Mount Vernon, MO 65712-1407
Phone (417) 466-4110
108 S Hickory St
Mount Vernon, MO 65712-1407
Phone (417) 466-4110
543 W Hubble Dr
Marshfield, MO 65706-1532
Phone (417) 859-4878
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081126000092 | MO | Practitioner - Family Practice |
7214097906 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aria Vision Care, LLC | Past | Accepting new patients | |
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R2H29 | MO | Yes |
Addresses
Primary practice location
101 S Main St
Rogersville, MO 65742-9357
Mailing address
101 S Main St
Rogersville, MO 65742-9357
Phone (417) 753-9404
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 26111 | Other | MO | BLUE CROSS BLUE SHIELD |
| 242498541 | Medicaid | MO |
NPI Registry JSON
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660694400000",
"number": "1073604690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 S MAIN ST",
"city": "ROGERSVILLE",
"state": "MO",
"postal_code": "657429357",
"telephone_number": "417-753-9404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 S MAIN ST",
"city": "ROGERSVILLE",
"state": "MO",
"postal_code": "657429357",
"telephone_number": "417-753-9404",
"fax_number": "417-753-9137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACMILLAN",
"first_name": "PATRICK",
"middle_name": "EDWARD",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2022-08-17",
"certification_date": "2022-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "R2H29",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "26111",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "242498541",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rogersville, MO
- L&J Pharmacy Inc
- L&J Pharmacy Inc
- Lester E Cox Medical Centers
- Lester E. Cox Medical Centers
- Logan Rogersville R-VIII
- Gayla Manary
- Rebecca Jean McAtee
- Kristal Kae McCleary
- McGuire Christian Counseling Inc
- Lisa Ann Melgren
All providers in Rogersville, MO · Family Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.