NPIMap

Organization Active NPI

Capital Region Medical Center

Doing business as Capital Region Physicians - Southwest

  • Family Medicine Physician
  • Jefferson City, MO
National Provider Identifier
1124091285
Registry record updated Aug 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CAPITAL REGION MEDICAL CENTER
Doing business as
Capital Region Physicians - Southwest
Practice address
1500 Southwest Blvd
Ste D
Jefferson City, MO 65109
Phone
(573) 632-5780
Fax
(573) 632-5833
NPI assigned
Feb 9, 2006
Last updated
Aug 23, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2013

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

Authorized official

Name
Tom Luebbering
Title
VP of Finance
Phone
(573) 632-5100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Nurse Practitioner 363L00000X

Addresses

Primary practice location

1500 Southwest Blvd
Ste D
Jefferson City, MO 65109

Mailing address

1500 Southwest Blvd
Ste D
Jefferson City, MO 65109
Phone (573) 632-5780

Other identifiers 2

IdentifierTypeStateIssuer
502474406MedicaidMO
CH7258OtherMORR MEDICARE

Other names 1

  • Capital Region Physicians - Southwest Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Capital Region Medical Center47 organizations share this tax ID, including this one

Other organizations with this tax ID 46

Organizations that report the same tax identification number in the National Provider Directory.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377216000000",
    "number": "1124091285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 SOUTHWEST BLVD",
            "address_2": "STE D",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "65109",
            "telephone_number": "573-632-5780",
            "fax_number": "573-632-5833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 SOUTHWEST BLVD",
            "address_2": "STE D",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "65109",
            "telephone_number": "573-632-5780",
            "fax_number": "573-632-5833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITAL REGION MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-09",
        "last_updated": "2013-08-23",
        "status": "A",
        "authorized_official_last_name": "LUEBBERING",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "573-632-5100"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "502474406",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CH7258",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Capital Region Physicians - Southwest",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jefferson City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2013; 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.