NPIMap

Organization Active NPI

Thomas W. Kupferer, D.O.

Doing business as Desoto Family Medicine

  • Family Medicine Physician
  • De Soto, IL
National Provider Identifier
1184829996
Registry record updated Oct 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036099723 Issued in IL
Legal business name
THOMAS W. KUPFERER, D.O.
Doing business as
Desoto Family Medicine
Practice address
407 S Chestnut St
De Soto, IL 62924-1400
Phone
(618) 867-2703
Fax
(618) 867-2353
NPI assigned
Jun 20, 2007
Last updated
Oct 9, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2009

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

Authorized official

Name
Mrs. Janet L Austin
Title
Office Manager
Phone
(618) 687-2353

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 036066913 IL
Family Medicine Physician 207Q00000X 036099723 IL Primary

Addresses

Primary practice location

407 S Chestnut St
De Soto, IL 62924-1400

Mailing address

407 S Chestnut
PO Box 104
Desoto, IL 62924-1400
Phone (618) 867-2703

Other identifiers 2

IdentifierTypeStateIssuer
143890OtherILMEDICARE RURAL HEALTH
039-00152OtherILBCBS

Other names 1

  • DESOTO FAMILY MEDICINE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Desoto Family Medicine2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

407 S Chestnut St
De Soto, IL 62924
Phone (618) 867-2703

Practitioners & affiliated clinicians

Practitioners 3

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": "1182297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255046400000",
    "number": "1184829996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 S CHESTNUT",
            "address_2": "PO BOX 104",
            "city": "DESOTO",
            "state": "IL",
            "postal_code": "629241400",
            "telephone_number": "618-867-2703",
            "fax_number": "618-687-9511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 S CHESTNUT ST",
            "city": "DE SOTO",
            "state": "IL",
            "postal_code": "629241400",
            "telephone_number": "618-867-2703",
            "fax_number": "618-867-2353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS W. KUPFERER, D.O.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-20",
        "last_updated": "2009-10-09",
        "status": "A",
        "authorized_official_last_name": "AUSTIN",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "618-687-2353",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": "036066913",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036099723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RURAL HEALTH",
            "identifier": "143890",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "039-00152",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DESOTO FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in De Soto, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.