NPIMap

Individual provider Active NPI

Justin David Puckett, DO

  • Family Medicine Physician
  • Kirksville, MO
National Provider Identifier
1205044146
Registry record updated Sep 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2007018127 Issued in MO
Practice address
2004 N Baltimore St Ste a
Kirksville, MO 63501-5107
Phone
(660) 665-7575
Fax
(660) 665-7576
NPI assigned
May 21, 2007
Last updated
Sep 26, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2006017939 MO
Family Medicine Physician 207Q00000X 2007018127 MO Primary

Addresses

Primary practice location

2004 N Baltimore St Ste a
Kirksville, MO 63501-5107

Mailing address

PO Box 551
Hannibal, MO 63401-0551
Phone (660) 665-7575

Other identifiers 2

IdentifierTypeStateIssuer
MA1807001OtherMOMEDICARE
209398502MedicaidMO

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
I20090722000758 MO Practitioner - Family Practice 6103978101 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1611 S Baltimore St
Kirksville, MO 63501-4518
Phone (660) 665-7575

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2006017939MOMDFamily Medicine Physician
2007018127MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hannibal Regional Healthcare System Inc CurrentSince Jul 1, 2017 Accepting new patients
Hannibal Regional Healthcare System, Inc Current Accepting new patients
Hannibal Regional Healthcare System, Inc Family Medicine CurrentSince Jul 1, 2017 Accepting new patients
Physician Services of Missouri LLC Family Medicine Past Accepting new patients
La Plata Nursing Home District Past Accepting new patients

Locations

6500 Hospital Dr
Hannibal, MO 63401
Phone (573) 629-3400

1611 S Baltimore St
Kirksville, MO 63501
Phone (660) 372-9595

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10040602
  • Direct secure messaging: justin.puckett.p1@direct.cfmkv.nextgenshare.com

Organizations & group practices 5

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 10

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": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537920000000",
    "number": "1205044146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634010551",
            "telephone_number": "660-665-7575",
            "fax_number": "660-665-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2004 N BALTIMORE ST STE A",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635015107",
            "telephone_number": "660-665-7575",
            "fax_number": "660-665-7576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "JUSTIN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-21",
        "last_updated": "2018-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2006017939",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2007018127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "MA1807001",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209398502",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirksville, MO

Sources for this page

Verify at the official NPI Registry.