NPIMap

Individual provider Active NPI

Seong-Wook Seo, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Bolivar, MO
National Provider Identifier
1104213180
Registry record updated Apr 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
2020001901 Issued in MO
Practice address
1155 W Parkview St Ste 1C
Bolivar, MO 65613-7800
Phone
(417) 326-7246
Fax
(417) 777-2968
NPI assigned
Apr 17, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 2020001901 MO
Pain Medicine (Anesthesiology) Physician 207LP2900X 2020001901 MO Primary

Addresses

Primary practice location

1155 W Parkview St Ste 1C
Bolivar, MO 65613-7800

Mailing address

1500 N Oakland Ave
Bolivar, MO 65613-3011
Phone (417) 326-6000

Other practice location 1

1 University of New Mexico
MSC 10-6000
Albuquerque, NM 87131
Phone (720) 585-4947

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address citizensmemorialhospital@mhccaremail.com Health Information Exchange (HIE)

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
I20200930001895 MO Practitioner - Interventional Pain ManagementPractitioner - AnesthesiologyPractitioner - Pain Management 5799091245 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional Pain ManagementAlso: Anesthesiology
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Citizens Memorial HealthcareGroup PAC ID 4183528169, 144 clinicians

Practice addresses (Care Compare)

1155 W Parkview St
1C
Bolivar, MO 65613-8279
Phone (417) 326-7246

1500 N Oakland Ave
Bolivar, MO 65613-3011

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Citizens Memorial Hospital District Anesthesiology CurrentSince Oct 14, 2023 Accepting new patients
Citizens Memorial Healthcare CurrentSince Jul 27, 2020 Accepting new patients
Citizens Memorial Healthcare Pain Medicine CurrentSince Jul 27, 2020 Accepting new patients
Citizens Memorial Hospital District CurrentSince Oct 14, 2023 Accepting new patients

Locations

1500 N Oakland Ave
Ste 135
Bolivar, MO 65613

1500 N Oakland Ave
Bolivar, MO 65613
Phone (417) 326-6000

1155 W Parkview St
Ste 1C
Bolivar, MO 65613
Phone (417) 326-7246

Organizations & group practices 4

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 10

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": "1429228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619136000000",
    "number": "1104213180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N OAKLAND AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656133011",
            "telephone_number": "417-326-6000",
            "fax_number": "417-328-6338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 W PARKVIEW ST STE 1C",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656137800",
            "telephone_number": "417-326-7246",
            "fax_number": "417-777-2968"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 University of New Mexico",
            "address_2": "MSC 10-6000",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "87131",
            "country_code": "US",
            "telephone_number": "720-585-4947",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SEO",
        "first_name": "SEONG-WOOK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-17",
        "last_updated": "2021-04-23",
        "certification_date": "2021-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "2020001901",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "MO",
            "license": "2020001901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "citizensmemorialhospital@mhccaremail.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1155 W Parkview St Ste 1C",
            "city": "Bolivar",
            "state": "MO",
            "country_code": "US",
            "postal_code": "656137800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bolivar, MO

Sources for this page

Verify at the official NPI Registry.