NPIMap

Organization Active NPI

Jefferson City Medical Group, PC

Doing business as JCMG Pain Management

  • Pain Medicine (Anesthesiology) Physician
  • Jefferson City, MO
National Provider Identifier
1164830337
Registry record updated Dec 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
2002003282 Issued in MO
Legal business name
JEFFERSON CITY MEDICAL GROUP, PC
Doing business as
JCMG Pain Management
Practice address
1241 W Stadium Blvd
Jefferson City, MO 65109-6023
Phone
(573) 635-5264
NPI assigned
Jul 31, 2014
Last updated
Dec 26, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2018

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

Authorized official

Name
Jeffrery Lee Patrick, MD
Title
President
Phone
(573) 635-5264

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X 2002003282 MO Primary

Addresses

Primary practice location

1241 W Stadium Blvd
Jefferson City, MO 65109-6023

Mailing address

PO Box 104240
Jefferson City, MO 65110-4240
Phone (573) 635-5264

Other names 1

  • JCMG Pain Management Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040901000004 MO Part B Supplier - Clinic/Group Practice 1850371089 Receives reassigned benefits from 10 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jefferson Cty, MO; Jefferson City, MO

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Jeffferson City Medical12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545782400000",
    "number": "1164830337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 104240",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651104240",
            "telephone_number": "573-635-5264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 W STADIUM BLVD",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096023",
            "telephone_number": "573-635-5264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON CITY MEDICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-31",
        "last_updated": "2018-12-26",
        "status": "A",
        "authorized_official_last_name": "PATRICK",
        "authorized_official_first_name": "JEFFRERY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-635-5264",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "MO",
            "license": "2002003282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JCMG Pain Management",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "JCMG Pain Management",
            "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 Dec 26, 2018; 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.