NPIMap

Individual provider Active NPI

Jeremy Shaun Talley, D.O.

  • Family Medicine Physician
  • Hermann, MO
National Provider Identifier
1184847659
Registry record updated Feb 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2007006309 Issued in MO
Practice address
1714 Wein St
Hermann, MO 65041-1571
Phone
(573) 486-2118
Fax
(573) 486-3533
NPI assigned
Apr 11, 2007
Last updated
Feb 9, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2007006309 MO
Family Medicine Physician 207Q00000X 2007006309 MO Primary
Family Medicine Physician 207Q00000X 036.117295 IL

Addresses

Primary practice location

1714 Wein St
Hermann, MO 65041-1571

Mailing address

PO Box 19
Hermann, MO 65041-0019
Phone (573) 486-2118

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
I20080114000817 MO Practitioner - Family Practice 5698856839 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aging Well Health Care, LLCGroup PAC ID 1153232038, 236 clinicians
Mercy Hospital LincolnGroup PAC ID 5193040020, 31 clinicians
Lincoln County Memorial HospitalGroup PAC ID 5395632327, 4 clinicians

Practice addresses (Care Compare)

7212 Balson Ave
Saint Louis, MO 63130-3001

900 E Cherry St
Troy, MO 63379-1429
Phone (636) 528-8585

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.117295ILMDFamily Medicine Physician
2007006309MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Lincoln CurrentSince Apr 18, 2015 Accepting new patients
Mercy Hospital Lincoln Family Medicine CurrentSince Apr 18, 2015 Accepting new patients

Locations

900 E Cherry St
Troy, MO 63379
Phone (636) 528-8585

Interoperability endpoints

  • Direct secure messaging: jtalley760604@directc.mercy.net

Organizations & group practices 3

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": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328745600000",
    "number": "1184847659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19",
            "city": "HERMANN",
            "state": "MO",
            "postal_code": "650410019",
            "telephone_number": "573-486-2118",
            "fax_number": "573-486-3533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1714 WEIN ST",
            "city": "HERMANN",
            "state": "MO",
            "postal_code": "650411571",
            "telephone_number": "573-486-2118",
            "fax_number": "573-486-3533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TALLEY",
        "first_name": "JEREMY",
        "middle_name": "SHAUN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2012-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2007006309",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2007006309",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.117295",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hermann, MO

Sources for this page

Verify at the official NPI Registry.