NPIMap

Individual provider Active NPI

Philip L Rumbaoa, MD

  • Phlebology Physician
  • Jefferson City, MO
National Provider Identifier
1083686661
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Phlebology PhysicianTaxonomy code 202K00000X
License
2000163033 Issued in MO
Practice address
1241 W Stadium Blvd
Jefferson City, MO 65109-6023
Phone
(573) 635-5264
NPI assigned
Feb 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Phlebology Physician 202K00000X 036115065 IL
Phlebology Physician 202K00000X 0426821 KS
Family Medicine Physician 207Q00000X 036115065 IL
Family Medicine Physician 207Q00000X 0426821 KS
Family Medicine Physician 207Q00000X 2000163033 MO
Phlebology Physician 202K00000X 2000163033 MO Primary

Addresses

Primary practice location

1241 W Stadium Blvd
Jefferson City, MO 65109-6023

Mailing address

1330 Grace LN
Boonville, MO 65233-2146
Phone (660) 537-0285

Other practice location 1

4004 Peach Ct
Suite E
Columbia, MO 65203-3800
Phone (573) 449-2273

Other identifiers 2

IdentifierTypeStateIssuer
25213101OtherMOBLUE CROSS BLUE SHIELD OF KANSAS CITY
25213121OtherKSBLUE CROSS BLUE SHIELD OF KANSAS CITY

Other names 1

  • Dr. Philip Rumbaoa Professional name

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
I20050202000164 MO Practitioner - Family PracticePractitioner - Vascular SurgeryPractitioner - Emergency Medicine 8729039227 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kansas School of Med (KC/Wich/Sal), 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson City Medical Group PCGroup PAC ID 1850371089, 117 clinicians

Practice addresses (Care Compare)

1241 W Stadium Blvd
Jefferson City, MO 65109-6023
Phone (573) 556-5771

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal595

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036115065ILMDPhlebology Physician
0426821KSMDPhlebology Physician
2000163033MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson City Medical Group, P.C. Family Medicine CurrentSince Feb 19, 2018 Accepting new patients
Jefferson City Medical Group, P.C. CurrentSince Feb 19, 2018 Accepting new patients
Jefferson City Medical Group, P.C. Current Accepting new patients
Jefferson City Medical Group, P.C. Current Accepting new patients
USA Vein Clinics of Decatur LLC Family Medicine Past Accepting new patients
Kansas City Phlebology Medical Group PA Phlebology PastSince Apr 1, 2005 Accepting new patients
Jefferson City Medical Group, P.C. Family Medicine Past Accepting new patients
Missouri Phlebology Inc Phlebology Past Accepting new patients
Missouri Vein Care, LLC Phlebology PastSince Jul 31, 2003 Accepting new patients

Locations

1241 W Stadium Blvd
#L400B
Jefferson Cty, MO 65109
Phone (573) 556-7724

1241 W Stadium Blvd
Jefferson Cty, MO 65109
Phone (573) 556-5771

200 Saint Marys Plz
Ste 203
Jefferson Cty, MO 65101
Phone (573) 632-2780

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
  • Direct secure messaging: philip.rumbaoa@jcmg.eclinicaldirectplus.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1083686661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 GRACE LN",
            "city": "BOONVILLE",
            "state": "MO",
            "postal_code": "652332146",
            "telephone_number": "660-537-0285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 W STADIUM BLVD",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096023",
            "telephone_number": "573-635-5264"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4004 Peach Ct",
            "address_2": "Suite E",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652033800",
            "country_code": "US",
            "telephone_number": "573-449-2273",
            "fax_number": "573-449-2299",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUMBAOA",
        "first_name": "PHILIP",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "202K00000X",
            "taxonomy_group": "",
            "desc": "Phlebology",
            "state": "IL",
            "license": "036115065",
            "primary": false
        },
        {
            "code": "202K00000X",
            "taxonomy_group": "",
            "desc": "Phlebology",
            "state": "KS",
            "license": "0426821",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036115065",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "0426821",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2000163033",
            "primary": false
        },
        {
            "code": "202K00000X",
            "taxonomy_group": "",
            "desc": "Phlebology",
            "state": "MO",
            "license": "2000163033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF KANSAS CITY",
            "identifier": "25213101",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF KANSAS CITY",
            "identifier": "25213121",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PHILIP",
            "last_name": "RUMBAOA",
            "prefix": "DR.",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Jefferson City, MO

Sources for this page

Verify at the official NPI Registry.