Active NPI
Dennis M Handley, MD
- Family Medicine Physician
- Boonville, MO
National Provider Identifier
1114964798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MDR7966
- Practice address
- 17601 B Hwy
Boonville, MO 65233-2839 - Phone
- (660) 882-2121
- Fax
- (660) 882-7073
- NPI assigned
- Jun 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MDR7966 | MO | Primary |
Addresses
Primary practice location
17601 B Hwy
Boonville, MO 65233-2839
Mailing address
PO Box 88
17651 B. Highway
Boonville, MO 65233-0088
Phone (660) 882-2121
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201300019 | Medicaid | MO | |
| 80052848 | Other | MO | RR MEDICARE |
| 104106 | Other | MO | UNITED HEALTHCARE |
| 2086349401 | Other | KS | KANSAS MEDICAID |
| 9098 | Other | MO | BLUE SHIELD/BLUE CHOICE |
| 102982 | Other | MO | HEALTHLINK |
| 500300006 | Other | MEDICARE PTAN |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MDR7966 | MO | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408924800000",
"number": "1114964798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 88",
"address_2": "17651 B. HIGHWAY",
"city": "BOONVILLE",
"state": "MO",
"postal_code": "652330088",
"telephone_number": "660-882-2121",
"fax_number": "660-882-7073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17601 B HWY",
"city": "BOONVILLE",
"state": "MO",
"postal_code": "652332839",
"telephone_number": "660-882-2121",
"fax_number": "660-882-7073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANDLEY",
"first_name": "DENNIS",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-01",
"last_updated": "2014-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "MDR7966",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201300019",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "80052848",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "104106",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KANSAS MEDICAID",
"identifier": "2086349401",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD/BLUE CHOICE",
"identifier": "9098",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "102982",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "500300006",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Boonville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.