Daniel P Lavery, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

R9J28 Issued in MO

Practice address

1616 Southridge Dr
Suite #203
Jefferson City, MO 65109-5677

Phone

(573) 659-7300

Fax

(573) 636-0555

NPI assigned

Sep 14, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Family Medicine of Jefferson City, LLC

  • Family Medicine Physician
  • Jefferson City, MO
  • NPI 1043319957
  NPD (past) Authorized official
• Capital Region Medical Center

  • Cardiovascular Disease Physician
  • Jefferson City, MO
  • NPI 1659973857
  NPD (past)
• SSM Regional Health Services

  • Rural Health Clinic/Center
  • Tipton, MO
  • NPI 1588601777
  NPD (past)

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1083719975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 SYCAMORE VALLEY DR",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651093133",
            "telephone_number": "573-616-8832",
            "fax_number": "573-635-2237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 SOUTHRIDGE DR",
            "address_2": "SUITE #203",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651095677",
            "telephone_number": "573-659-7300",
            "fax_number": "573-636-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAVERY",
        "first_name": "DANIEL",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R9J28",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "171243",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "202387284",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "185912",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordan Larsen, LCSW
• Phyllis Larson, LPC
• Justin Lauf
• Aaron Joseph Laughlin, DO
• Katelyn Laughlin
• Carol A Lawler, LPN
• Lawrence Dental Services LLC
• Krystal I Lea, LPN
• Madeline Laura Irene Leal, PHARMD
• Kevin Andrew Lease, MD

• Family Medicine Physician in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.