John Gamble III, M.D.
Individual provider Active NPI Diagnostic Radiology Physician · Hannibal, MO
NPI 1174528111 · NPPES record last updated Nov 30, 2007
Key facts
- NPI
- 1174528111
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 2000160347 (MO)
- Practice address
- 217 Butternut St
Hannibal, MO 63401-6546 - Phone
- (573) 231-0858
- Fax
- (573) 231-0861
- NPI assigned
- Jun 16, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 23
Hospital & facility affiliations 14
Medicare Care Compare profile
- Specialty
- Diagnostic Radiology
- Education
- Meharry Medical College School of Medicine, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Citizens Memorial Healthcare
Citizens Memorial Hospital District
Practice addresses (Care Compare)
Bolivar, MO 65613
Phone (417) 328-6631
1155 W Parkview
Bolivar, MO 65613-7800
1155 W Parkview St
Bolivar, MO 65613-7800
1500 N Oakland Ave
Citizens Memorial Hospital
Bolivar, MO 65613-3011
Phone (417) 326-6000
1500 N Oakland Ave
CMH Diabetes
Bolivar, MO 65613-3099
Phone (417) 328-6040
Hospital & facility affiliations
- Citizens Memorial Hospital
- Cox Medical Centers
- Cedar County Memorial Hospital
- Mercy Hospital Springfield
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
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080306000683 | MO | Practitioner - Diagnostic Radiology | 8123932241 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000160347 | MO | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Missouri Imaging Associates, Inc. | Diagnostic Radiology | Past | Accepting new patients |
| Community Memorial Hospital District | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 2000160347 | MO | Yes |
Addresses
Primary practice location
217 Butternut St
Hannibal, MO 63401-6546
Mailing address
217 Butternut St
Hannibal, MO 63401-6546
Phone (573) 231-0858
Other providers in Hannibal, MO
- Michelle N Friedersdorf
- Scott C Friedersdorf
- Friends Are Family, Inc.
- Jessica Dyan Friesz
- Sara Galliher
- Lisa Michelle Gard
- Scott Alan Gard
- Emily Garrett
- Genoa Healthcare LLC
- Kathleen Gerding
All providers in Hannibal, MO · Diagnostic Radiology 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 Nov 30, 2007. 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.
- 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.