Active NPI
Frederick D. Harris Jr., MD
- Diagnostic Radiology Physician
- Cape Girardeau, MO
National Provider Identifier
1124034657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 2005036999
- Practice address
- 70 Doctors Park
Cape Girardeau, MO 63703-4928 - Phone
- (573) 334-6071
- Fax
- (573) 334-4739
- NPI assigned
- Aug 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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 2005036999 | MO | Primary |
Addresses
Primary practice location
70 Doctors Park
Cape Girardeau, MO 63703-4928
Mailing address
70 Doctors Park
Cape Girardeau, MO 63703-4928
Phone (573) 334-6071
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 185214 | Other | MO | MO BLUE CROSS BLUE SHIELD |
| 430954380CAP | Other | MERCY HEALTH PLAN | |
| 123361 | Other | HEALTHLINK | |
| 207216201 | Medicaid | MO | |
| 063896 | Other | HEALTH ALLIANCE | |
| 036-107646 | Other | IL | IL BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL, MO, KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 3
Care Compare profile
Medicare Care Compare- Specialty
- Diagnostic Radiology
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
130 Pin Oak LN
Harrisburg, IL 62946-5902
Phone (573) 335-6671
1530 Lone Oak Rd
Paducah, KY 42003-7901
Phone (270) 444-2444
434 N W St
Perryville, MO 63775-1359
Phone (573) 547-2536
70 Doctors Park
Cape Girardeau, MO 63703-4928
Phone (573) 334-6071
Hospital & facility affiliations
- Herrin Hospital
- Mercy Health - Lourdes Hospital
- Memorial Hospital of Carbondale
- Saint Francis Medical Center
- Poplar Bluff Regional Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005036999 | MO | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Hospital Perry | Diagnostic Radiology | Current | Accepting new patients |
| Mercy Hospital Perry | Current | Accepting new patients | |
| Mercy Hospital Perry | Current | Accepting new patients |
Locations
434 N West St
Perryville, MO 63775
Phone (573) 547-2530
Organizations & group practices 4
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.
-
- Rural Health Clinic/Center
- Perryville, MO
- NPI 1639858855
-
- Rural Health Clinic/Center
- Perryville, MO
- NPI 1720767940
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Poplar Bluff, MO
- NPI 1700831724
-
- General Acute Care Hospital
- Cape Girardeau, MO
- NPI 1467412726
-
- General Acute Care Hospital
- Paducah, KY
- NPI 1346244126
-
- General Acute Care Hospital
- Carbondale, IL
- NPI 1093801797
-
- General Acute Care Hospital
- Herrin, IL
- NPI 1528158573
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620172800000",
"number": "1124034657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "70 DOCTORS PARK",
"city": "CAPE GIRARDEAU",
"state": "MO",
"postal_code": "637034928",
"telephone_number": "573-334-6071",
"fax_number": "573-334-4739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "70 DOCTORS PARK",
"city": "CAPE GIRARDEAU",
"state": "MO",
"postal_code": "637034928",
"telephone_number": "573-334-6071",
"fax_number": "573-334-4739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "FREDERICK",
"middle_name": "D.",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-01",
"last_updated": "2021-05-05",
"certification_date": "2021-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MO",
"license": "2005036999",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MO BLUE CROSS BLUE SHIELD",
"identifier": "185214",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCY HEALTH PLAN",
"identifier": "430954380CAP",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "123361",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "207216201",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "063896",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IL BLUE CROSS BLUE SHIELD",
"identifier": "036-107646",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cape Girardeau, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; 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.