James Hawk, MD

Key facts

NPI

1144247693

Entity type

Individual (NPI type 1)

Primary specialty

Family Medicine Physician 207Q00000X

License

01041064A (IN)

Practice address

200 Healthway
Potosi, MO 63664-1420

Phone

(573) 438-0751

Fax

(573) 438-5460

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

No

Organizations & group practices 3

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.

• BC Missouri Emergency Physicians, LLP Emergency Medicine Physician · Farmington, MO · NPI 1396760062
  NPD (past) EMERGENCY MEDICINE
• BC Missouri Emergency Physicians, LLP Emergency Medicine Physician · Bonne Terre, MO · NPI 1952326621
  NPD (past) EMERGENCY MEDICINE
• Twin City Healt Services Pain Clinic/Center · Crystal City, MO · NPI 1114944196
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 17, 2014.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402963200000",
    "number": "1144247693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 HEALTHWAY",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636641420",
            "telephone_number": "573-438-0751",
            "fax_number": "573-438-5460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HEALTHWAY",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636641420",
            "telephone_number": "573-438-0751",
            "fax_number": "573-438-5460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAWK",
        "first_name": "JAMES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2014-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2000164180",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-086677",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01041064A",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G-43387",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01041064A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207368101",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "935623210",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Potosi, MO · Family Medicine Physician in Missouri