Sandy R Hagene, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

112906 Issued in MO

Practice address

102 Ozark Dr
Cuba, MO 65453

Phone

(573) 885-6600

Fax

(573) 885-6610

NPI assigned

Aug 23, 2006

Last updated

May 13, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Missouri Baptist Hospital of SullivanGroup PAC ID 2668380148, shared by 8 NPIs, 40 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• BJC Home Care Services Home health agency, Saint Louis, MO, CCN 267276

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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.

• Missouri Baptist Hospital of Sullivan

  • Critical Access Hospital
  • Sullivan, MO
  • NPI 1295743169
  Medicare reassignment NPD
• Missouri Baptist Hospital of Sullivan

  dba Cuba Medical Office

  • Rural Health Clinic/Center
  • Cuba, MO
  • NPI 1396827408
  Medicare reassignment NPD
• Missouri Baptist Hospital of Sullivan

  dba Missouri Baptist Sullivan Hospital

  • Ambulance
  • Sullivan, MO
  • NPI 1831343268
  NPD
• Missouri Baptist Hospital of Sullivan

  dba Missouri Baptist Sullivan Hospital

  • Multi-Specialty Clinic/Center
  • Sullivan, MO
  • NPI 1215945480
  NPD (past)
• Missouri Baptist Hospital of Sullivan

  dba Sullivan Medical Office

  • Rural Health Clinic/Center
  • Sullivan, MO
  • NPI 1235228222
  NPD (past)
• Missouri Baptist Hospital of Sullivan

  dba Riverside Medical Clinic

  • Rural Health Clinic/Center
  • Sullivan, MO
  • NPI 1962591958
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• BJC Home Care Services

  • Home Health Agency
  • Saint Louis, MO
  • NPI 1326077199
  Care Compare affiliation

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1184731671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 OZARK DR STE B",
            "city": "CUBA",
            "state": "MO",
            "postal_code": "654531664",
            "telephone_number": "573-885-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 OZARK DR",
            "city": "CUBA",
            "state": "MO",
            "postal_code": "65453",
            "telephone_number": "573-885-6600",
            "fax_number": "573-885-6610"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "965 Mattox Dr",
            "address_purpose": "LOCATION",
            "city": "Sullivan",
            "state": "MO",
            "postal_code": "630802365",
            "country_code": "US",
            "telephone_number": "573-860-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAGENE",
        "first_name": "SANDY",
        "middle_name": "R",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-23",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "112906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "424651305",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "102 Ozark Dr",
            "city": "Cuba",
            "state": "MO",
            "country_code": "US",
            "postal_code": "65453",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Susan Marie Frago, RN
• Donald James Fuchs, DDS
• Thomas L. Gibbon, DO
• Grace Gardens, LLC
• Louis Edward Hagene, D.C.
• Stacy Anne Hardwick, LPC
• Healthnet Regional Center of Cuba, Inc..
• John Wayne Hewkin, RPH.
• Samuel W Holland, LPC
• James Devon Huitt, PH.D., LMFT

• Family Nurse Practitioner in Cuba, MO
• Providers in Cuba, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.