NPIMap

Organization Active NPI

Jefferson City Medical Group, P.C.

  • Family Medicine Physician
  • Jefferson City, MO
National Provider Identifier
1104645274
Registry record updated Oct 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
JEFFERSON CITY MEDICAL GROUP, P.C.
Practice address
1735 Elm CT
Jefferson City, MO 65101-4129
Phone
(573) 634-4878
NPI assigned
Oct 7, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2024

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

Authorized official

Name
Dr. Jeffrey Patrick, M.D.
Title
President
Phone
(573) 635-5264

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1735 Elm CT
Jefferson City, MO 65101-4129

Mailing address

PO Box 104240
Jefferson City, MO 65110-4240
Phone (573) 635-5246

Other identifiers 3

IdentifierTypeStateIssuer
506292002MedicaidMO
CC7852OtherMOMEDICARE RAILROAD
0428190006OtherMODMERC/NORDIAN

Other names 1

  • Express Care- Elm Court Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241226001080 MO DME Supplier - Physician - Family Practice 1850371089 Practice locations: Jefferson City, MO

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Flu Shot Clinic12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1735 Elm Ct
Jefferson Cty, MO 65101
Phone (573) 634-4878

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1728259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728259200000",
    "number": "1104645274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 104240",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651104240",
            "telephone_number": "573-635-5246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1735 ELM CT",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651014129",
            "telephone_number": "573-634-4878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON CITY MEDICAL GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-07",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A",
        "authorized_official_last_name": "PATRICK",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-635-5264",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "506292002",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CC7852",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC/NORDIAN",
            "identifier": "0428190006",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Express Care- Elm Court",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jefferson City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.