Individual provider Active NPI

Zacharias Alan Dane, FNP-C

  • Family Nurse Practitioner
  • Farmington, MO
National Provider Identifier
1124758495
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2022022676 Issued in MO
Practice address
555 W Pine St
Farmington, MO 63640-1439
Phone
(573) 747-1510
Fax
(573) 747-1512
NPI assigned
Jun 10, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X F06220239 MO
Family Nurse Practitioner 363LF0000X 2022022676 MO Primary

Addresses

Primary practice location

555 W Pine St
Farmington, MO 63640-1439

Mailing address

555 W Pine St
Farmington, MO 63640-1439
Phone (573) 747-1510

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220713001119 MO Practitioner - Nurse Practitioner 0840671590 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Health Group, LLCGroup PAC ID 7214021385, 4 clinicians
Mercy Clinic East CommunitiesGroup PAC ID 7214827922, 573 clinicians

Practice addresses (Care Compare)

555 W Pine St
Farmington, MO 63640-1439
Phone (573) 474-1510

621 S New Ballas Rd
Suite 189a
Saint Louis, MO 63141-8255
Phone (314) 251-6335

851 E 5TH St
Washington, MO 63090-3130

Hospital & facility affiliations

  • Mercy Hospital Jefferson Hospital, Crystal City, MO, CCN 260023

Merit-based Incentive Payment System (MIPS)

Final score
95.62 of 100Reported as group
Quality
100
Improvement activities
40
Cost
75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F06220239MOMDNurse Practitioner
2022022676MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic East Communities Nurse Practitioner Current Accepting new patients
Midwest Health Group LLC CurrentSince Jul 23, 2023 Accepting new patients
Mercy Clinic East Communities CurrentSince Sep 1, 2025 Accepting new patients
Midwest Health Group Convenient Care, LLC Past Accepting new patients

Locations

55 Nesbit Dr
Bonne Terre, MO 63628
Phone (573) 358-1700

550 Maple Valley Dr
Farmington, MO 63640
Phone (573) 454-2466

555 W Pine St
Farmington, MO 63640
Phone (573) 474-1510

621 S New Ballas Rd
Ste 189A
Saint Louis, MO 63141
Phone (314) 251-6335

621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192

851 E 5th St
Ste 328
Washington, MO 63090
Phone (636) 239-1101

Organizations & group practices 8

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1654819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753920000000",
    "number": "1124758495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 W PINE ST",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636401439",
            "telephone_number": "573-747-1510",
            "fax_number": "573-747-1512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 W PINE ST",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636401439",
            "telephone_number": "573-747-1510",
            "fax_number": "573-747-1512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANE",
        "first_name": "ZACHARIAS",
        "middle_name": "ALAN",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-10",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "F06220239",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2022022676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, MO

Sources for this page

Verify at the official NPI Registry.