Douglas Steven Goracke, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

04-22640 Issued in KS

Practice address

509 W 18TH St
Hermann, MO 65041-1547

Phone

(573) 486-2191

Fax

(573) 486-0910

NPI assigned

Jun 9, 2005

Last updated

Oct 8, 2018By the provider in NPPES

Sex

Male

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538956800000",
    "number": "1114921889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19",
            "city": "HERMANN",
            "state": "MO",
            "postal_code": "650410019",
            "telephone_number": "573-486-1193",
            "fax_number": "573-486-0910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 W 18TH ST",
            "city": "HERMANN",
            "state": "MO",
            "postal_code": "650411547",
            "telephone_number": "573-486-2191",
            "fax_number": "573-486-0910"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Ravenhill Dr",
            "address_purpose": "LOCATION",
            "city": "Atchison",
            "state": "KS",
            "postal_code": "660029204",
            "country_code": "US",
            "telephone_number": "913-426-2336",
            "fax_number": "913-674-2013",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORACKE",
        "first_name": "DOUGLAS",
        "middle_name": "STEVEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2018-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "KS",
            "license": "04-22640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202985016",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL PROVIDER IDENTIFICATION",
            "identifier": "1114921889",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100133270A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "050018992",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jessica Marie Haug, P.A.

• Anesthesiology Physician in Hermann, MO
• Providers in Hermann, MO by specialty
• Anesthesiology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2018; 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.