Individual provider Active NPI

Jessee Danielle Kruse, MD

  • Internal Medicine Physician
  • Columbia, MO
National Provider Identifier
1194401968
Registry record updated Jun 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2023022080 Issued in MO
Practice address
1 Hospital Drive Dco58.00
Columbia, MO 65212
Phone
(573) 882-4438
Fax
(573) 884-9992
NPI assigned
Jun 26, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2023022080 MO
Internal Medicine Physician 207R00000X 2023022080 MO Primary

Addresses

Primary practice location

1 Hospital Drive Dco58.00
Columbia, MO 65212

Mailing address

1 Hospital Drive Dco58.00
Columbia, MO 65212
Phone (573) 882-4438

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230810003155 MO Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 8921460742

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1687737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1194401968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL DRIVE DCO58.00",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "65212",
            "telephone_number": "573-882-4438",
            "fax_number": "573-884-9992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL DRIVE DCO58.00",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "65212",
            "telephone_number": "573-882-4438",
            "fax_number": "573-884-9992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUSE",
        "first_name": "JESSEE",
        "middle_name": "DANIELLE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-26",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2023022080",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2023022080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.