Charles P. Bondurant, M.D.
Individual provider Active NPI Neurological Surgery Physician · Columbia, MO
NPI 1174515696 · NPPES record last updated Jul 22, 2020
Key facts
- NPI
- 1174515696
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neurological Surgery Physician 207T00000X
- License
- R8J14 (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
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 8
Owned or controlled facilities with NPI records 6
Medicare Care Compare profile
- 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 LLC
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
- Boone Hospital Center
- University of Missouri Health Care
- Macon County Samaritan Memorial Hospital
- Lake Regional Health System
- Moberly Regional Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Spinal fusion | 27 |
| Laminectomy or laminotomy (partial removal of spine bones) | 41 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Boone Hospital Center |
Hospital | Corporate Officer Corporate Director Operational/Managerial Control |
Apr 25, 2023 Apr 1, 2021 Apr 1, 2021 |
| Boone Hospital Center |
Hospital | Corporate Director Operational/Managerial Control |
Apr 1, 2021 Apr 1, 2021 |
| Boone Health Primary Care - Moberly |
Rural health clinic | Corporate Director | Apr 1, 2021 |
| Boone Health Primary Care - Medical Park |
Rural health clinic | Corporate Director | Apr 1, 2021 |
| Boone Health Primary Care - Boonville |
Rural health clinic | Corporate Director | Apr 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060630000171 | MO | Practitioner - Neurosurgery | 2365454774 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boone Physician Services, LLC | Current |
Accepting new patients | |
| Mid Missouri Neurosurgery, LLP | Neurological Surgery | Past |
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
- charlesbondurant@mhccaremail.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician | 207T00000X | R8J14 | MO | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 206949802 | Medicaid | MO |
Other providers in Columbia, MO
- Melody Ann Boling
- Olivia Louise Bolles
- Debra Jean Bolton
- Meghan Boltz
- Marilee Green Bomar
- Holly H Bondurant
- Linda Bonebrake
- Michael G Bonen
- Roger D Bonham
- Sarah Ann Bonner
All providers in Columbia, MO · Neurological Surgery Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.