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Organization Active NPI

Freeman Neosho Hospital

Doing business as Freeman Neosho Physician Group

  • Internal Medicine Physician
  • Neosho, MO
National Provider Identifier
1083045686
Registry record updated May 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
FREEMAN NEOSHO HOSPITAL
Doing business as
Freeman Neosho Physician Group
Practice address
336 S Jefferson St
Neosho, MO 64850-1769
Phone
(417) 347-6605
NPI assigned
Dec 6, 2013
Last updated
May 3, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2016

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

Authorized official

Name
Steven W Graddy
Title
Cfo
Phone
(417) 347-6678

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

336 S Jefferson St
Neosho, MO 64850-1769

Mailing address

PO Box 3810
Joplin, MO 64803-3810
Phone (417) 347-6605

Other names 1

  • Freeman Neosho Physician Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040729000101 MO Part B Supplier - Clinic/Group Practice 4284624552 Receives reassigned benefits from 65 practitioners
Practice locations: Anderson, MO; Neosho, MO

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

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
Freeman Neosho Physician GroupNeosho, MO, CCN 268722 Rural health clinic Operational/Managerial Control (100%) Feb 1, 2014
Freeman Clinic of AndersonAnderson, MO, CCN 268773 Rural health clinic Operational/Managerial Control (100%) Jul 1, 2018

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 65

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 65

NPI Registry JSON

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

{
    "created_epoch": "1386288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462233600000",
    "number": "1083045686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3810",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648033810",
            "telephone_number": "417-347-6605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 S JEFFERSON ST",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648501769",
            "telephone_number": "417-347-6605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREEMAN NEOSHO HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-06",
        "last_updated": "2016-05-03",
        "status": "A",
        "authorized_official_last_name": "GRADDY",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "417-347-6678"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Freeman Neosho Physician Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Neosho, MO

Sources for this page

Verify at the official NPI Registry.