Individual provider Active NPI

Jennifer Jiang

  • Family Medicine Physician
  • Columbia, MO
National Provider Identifier
1083724447
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
110547 Issued in MO
Practice address
1101 N Providence Rd
Columbia, MO 65203-4365
Phone
(573) 874-0008
NPI assigned
Aug 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 110547 MO Primary

Addresses

Primary practice location

1101 N Providence Rd
Columbia, MO 65203-4365

Mailing address

1101 N Providence Rd
Columbia, MO 65203-4365
Phone (573) 874-0008

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20040401000657 MO Practitioner - Family PracticePractitioner - Other (Physician) 6204828932 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Missouri, Columbia School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Hospital PerryGroup PAC ID 1153777826, 115 clinicians

Practice addresses (Care Compare)

434 N W St
Perryville, MO 63775-1359
Phone (573) 547-2536

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue11

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Perry Family Medicine CurrentSince Oct 1, 2023 Accepting new patients
Mercy Hospital Perry Current Accepting new patients
Southeast Missouri Hospital Physicians, LLC Family Medicine CurrentSince Aug 1, 2018 Accepting new patients
Mercy Hospital Perry Family Medicine CurrentSince Oct 1, 2023 Accepting new patients
Physician Groups LC Family Medicine Past Accepting new patients

Locations

1 Hospital Dr
#4140
Columbia, MO 65212
Phone (573) 882-3629

211 Saint Francis Dr
Cpe Girardeau, MO 63703
Phone (573) 331-3000

1701 Lacey St
Cpe Girardeau, MO 63701
Phone (573) 334-4822

434 N West St
Perryville, MO 63775
Phone (573) 547-2530

206 Hospital Ln
Ste 204
Perryville, MO 63775
Phone (573) 547-4899

206 Hospital Ln
Ste 201
Perryville, MO 63775
Phone (573) 547-4899

1508 Edgemont Blvd
Perryville, MO 63775
Phone (573) 339-2000

Organizations & group practices 5

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 1

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083724447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 N PROVIDENCE RD",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652034365",
            "telephone_number": "573-874-0008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 N PROVIDENCE RD",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652034365",
            "telephone_number": "573-874-0008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIANG",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "110547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.