NPIMap

Individual provider Active NPI

Charles P. Bondurant, M.D.

  • Neurological Surgery Physician
  • Columbia, MO
National Provider Identifier
1174515696
Registry record updated Jul 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
R8J14 Issued in MO
Practice address
1605 E Broadway
Suite 100
Columbia, MO 65201-8023
Phone
(573) 815-4242
Fax
(573) 815-4245
NPI assigned
Aug 19, 2005
Reactivated
Apr 12, 2006
Last updated
Jul 22, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X R8J14 MO Primary

Addresses

Primary practice location

1605 E Broadway
Suite 100
Columbia, MO 65201-8023

Mailing address

1605 E Broadway
Suite 100
Columbia, MO 65201-8023
Phone (573) 815-4242

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060630000171 MO Practitioner - Neurosurgery 2365454774 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
University of Oklahoma College of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Boone Physician Services LLCGroup PAC ID 6507090644, 243 clinicians

Practice addresses (Care Compare)

1600 E Broadway
Columbia, MO 65201-5844
Phone (573) 815-8000

1600 E Broadway Box 50 Attn Stephanie Windsor
Columbia, MO 65201-5844

1605 E Broadway
Columbia, MO 65201-8023

1705 E Broadway
Suite 280
Columbia, MO 65201-7185
Phone (573) 815-7119

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion27
Laminectomy or laminotomy (partial removal of spine bones)41
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Boone Physician Services, LLC CurrentSince Feb 1, 2014 Accepting new patients
Mid Missouri Neurosurgery, LLP Neurological Surgery PastSince Aug 2, 2020 Accepting new patients

Locations

1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000

1705 E Broadway
Ste 280
Columbia, MO 65201
Phone (573) 815-7119

Interoperability endpoints

  • Direct secure messaging: charlesbondurant@mhccaremail.com

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Boone Hospital CenterColumbia, MO, CCN 260068 Hospital Corporate Officer
Corporate Director
Operational/Managerial Control		 Apr 25, 2023
Apr 1, 2021
Apr 1, 2021
Boone Hospital CenterColumbia, MO, CCN 26T068 Hospital Corporate Director
Operational/Managerial Control		 Apr 1, 2021
Apr 1, 2021
Boone Health Primary Care - MoberlyMoberly, MO, CCN 793868 Rural health clinic Corporate Director Apr 1, 2021
Boone Health Primary Care - Medical ParkMexico, MO, CCN 793867 Rural health clinic Corporate Director Apr 1, 2021
Boone Health Primary Care - BoonvilleBoonville, MO, CCN 793869 Rural health clinic Corporate Director Apr 1, 2021

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595376000000",
    "number": "1174515696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 E BROADWAY",
            "address_2": "SUITE 100",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652018023",
            "telephone_number": "573-815-4242",
            "fax_number": "573-815-4245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 E BROADWAY",
            "address_2": "SUITE 100",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652018023",
            "telephone_number": "573-815-4242",
            "fax_number": "573-815-4245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONDURANT",
        "first_name": "CHARLES",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "deactivation_date": "2006-03-25",
        "reactivation_date": "2006-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "MO",
            "license": "R8J14",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.