Mondrakus Harper

Key facts

NPI

1194426767

Entity type

Individual (NPI type 1)

Primary specialty

Phlebotomy Technician 246RP1900X

License

B6P44F8Q3 (KY)

Practice address

12565 Evening Shade Dr
Black Jack, MO 63033-8513

Phone

(314) 583-1477

Fax

(314) 216-3926

NPI assigned

Mar 13, 2023

Sex

Male

Sole proprietor

Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bevel Up Mobile Phlebotomy LLC Home Health Agency · Black Jack, MO · NPI 1659055887
  NPD Authorized official

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 13, 2023.

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678665600000",
    "number": "1194426767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12565 EVENING SHADE DR",
            "city": "BLACK JACK",
            "state": "MO",
            "postal_code": "630338513",
            "telephone_number": "314-583-1477",
            "fax_number": "314-216-3926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12565 EVENING SHADE DR",
            "city": "BLACK JACK",
            "state": "MO",
            "postal_code": "630338513",
            "telephone_number": "314-583-1477",
            "fax_number": "314-216-3926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARPER",
        "first_name": "MONDRAKUS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246RP1900X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": "KY",
            "license": "B6P44F8Q3",
            "primary": true
        },
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "MO",
            "license": "134849",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Black Jack, MO · Phlebotomy Technician in Missouri