NPIMap

Organization Active NPI

McPherson Medical & Diagnostic, LLC

  • Family Medicine Physician
  • Kennett, MO
National Provider Identifier
1124679774
Registry record updated Jun 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MCPHERSON MEDICAL & DIAGNOSTIC, LLC
Practice address
304 Teaco Rd Ste a
Kennett, MO 63857-3268
Phone
(573) 717-1072
NPI assigned
Sep 25, 2019
Last updated
Jun 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2023

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

Authorized official

Name
Amelia Doris Ledbetter
Title
Director of Operations
Phone
(573) 335-4715

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Clinic/Center 261Q00000X NU

Addresses

Primary practice location

304 Teaco Rd Ste a
Kennett, MO 63857-3268

Mailing address

PO Box 12545
Belfast, ME 04915-4016

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061201000167 MO Part B Supplier - Clinic/Group Practice 5698773539 Receives reassigned benefits from 116 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kennett, MO; Macon, MO; Malden, MO; Saint Louis, MO; Saint Peters, MO; Scott City, MO; Steele, MO; Moberly, MO…

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 23

National Provider Directory

National Provider Directory
Tax ID family
McPherson Medical Diagnost37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

Locations

211 Teaco Rd
Kennett, MO 63857
Phone (573) 888-0001

1706 Prospect Dr
Macon, MO 63552
Phone (660) 385-1006

10004 Kennerly Rd
Ste 186B
Saint Louis, MO 63128
Phone (314) 543-5969

5203 Chippewa St
Ste 201
Saint Louis, MO 63109
Phone (314) 858-6909

845 N New Ballas Ct
Ste 202
Saint Louis, MO 63141
Phone (314) 965-6033

4200 N Cloverleaf Dr
Ste H
Saint Peters, MO 63376
Phone (636) 928-1800

16922 Telge Rd
Ste 2G
Cypress, TX 77429
Phone (573) 559-3591

Practitioners & affiliated clinicians

Practitioners 100

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 100

NPI Registry JSON

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

{
    "created_epoch": "1569369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1124679774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12545",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 TEACO RD STE A",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638573268",
            "telephone_number": "573-717-1072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCPHERSON MEDICAL & DIAGNOSTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-25",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A",
        "authorized_official_last_name": "LEDBETTER",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_middle_name": "DORIS",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "573-335-4715"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennett, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.