Nancy D Lodge, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

31111 Issued in AZ

Practice address

611 W Main St
Fredericktown, MO 63645-1111

Phone

(573) 783-3341

NPI assigned

Jan 4, 2007

Last updated

Jun 5, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Nancy Barnett Former name

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

Specialty

Pediatric Medicine

Education

Eastern Virginia Medical School, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Madison Medical Center Stockhoff Memorial Nursing HomeGroup PAC ID 1355255886, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Madison Medical Center Stockhoff Memorial Nursing Home

  • Critical Access Hospital
  • Fredericktown, MO
  • NPI 1720163025
  Medicare reassignment Care Compare group NPD
• Madison Medical Center Stockhoff Memorial Nursing Home

  dba Madison Medical Center

  • Skilled Nursing Facility
  • Fredericktown, MO
  • NPI 1215003041
  NPD
• Madison Medical Center Stockhoff Memorial Nursing Home

  • Rural Health Clinic/Center
  • Fredericktown, MO
  • NPI 1467539031
  NPD (past)

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433462400000",
    "number": "1104973858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W MAIN ST",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451111",
            "telephone_number": "573-783-3341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W MAIN ST",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451111",
            "telephone_number": "573-783-3341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LODGE",
        "first_name": "NANCY",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2015-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "31111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "1Z9363",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164351",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "4575331",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "AZ0729800",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NANCY",
            "last_name": "BARNETT",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Frank T Klima, APRN-BC
• Susan Lee Krydynski, OTR/L
• Ava Madeline Laut
• Jeremy I Leach, R.PH.
• Angela D Lewis, LPC
• Madison County Adult Learning Center
• Madison County Ambulance District
• Madison County Council for Developmentally Disabled
• Madison County Council for Developmentally Disabled, Inc.
• Madison County Health Department

• Pediatrics Physician in Fredericktown, MO
• Providers in Fredericktown, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.