Individual provider Active NPI

William B Campbell, DO

  • Family Medicine Physician
  • Nixa, MO
National Provider Identifier
1114919347
Registry record updated Mar 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R2D18 Issued in MO
Practice address
105A Ridgecrest
Nixa, MO 65714-7807
Phone
(417) 725-8250
Fax
(417) 725-8253
NPI assigned
Aug 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2009

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 R2D18 MO Primary

Addresses

Primary practice location

105A Ridgecrest
Nixa, MO 65714-7807

Mailing address

105A Ridgecrest
Nixa, MO 65714-7807
Phone (417) 725-8250

Other identifiers 2

IdentifierTypeStateIssuer
P00174740OtherRR MEDICARE
241836204MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Sgoh Acquisition Inc PastSince Jul 25, 2005 Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237248000000",
    "number": "1114919347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105A RIDGECREST",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "657147807",
            "telephone_number": "417-725-8250",
            "fax_number": "417-725-8253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105A RIDGECREST",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "657147807",
            "telephone_number": "417-725-8250",
            "fax_number": "417-725-8253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "WILLIAM",
        "middle_name": "B",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2009-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R2D18",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00174740",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "241836204",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nixa, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.