NPIMap

Individual provider Active NPI

Evgeniya Banina, M.D.

  • Internal Medicine Physician
  • Eldon, MO
National Provider Identifier
1205280427
Registry record updated Jul 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2019024533 Issued in MO
Practice address
304A E 4TH St
Eldon, MO 65026
Phone
(573) 392-5654
Fax
(573) 392-5692
NPI assigned
Apr 14, 2016
Last updated
Jul 9, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2019024533 MO Primary

Addresses

Primary practice location

304A E 4TH St
Eldon, MO 65026

Mailing address

701 W 5TH St
Odessa, TX 79763-4206
Phone (432) 703-5375

Other practice location 1

701 W 5th St
Odessa, TX 79763-4206
Phone (432) 703-5375

Other practice location 2

2333 Highway 17
Iberia, MO 65486-9331
Phone (573) 793-6900

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
I20190724000298 MO Practitioner - Internal Medicine 2062707219 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Regional Health SystemGroup PAC ID 9133026776, 132 clinicians

Practice addresses (Care Compare)

302 E 4TH St
Eldon, MO 65026-1808
Phone (573) 392-9400

54 Hospital Dr
Osage Beach, MO 65065-3050

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.19 of 100Reported as group
Promoting interoperability
100
Improvement activities
40
Cost
75.51

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Regional Health System Current Accepting new patients
Lake Regional Health System CurrentSince Aug 1, 2019 Accepting new patients
Lake Regional Health System Internal Medicine CurrentSince Aug 1, 2019 Accepting new patients

Locations

304A E 4th St
Eldon, MO 65026
Phone (573) 392-5654

2333 Highway 17
Iberia, MO 65486
Phone (573) 793-6900

54 Hospital Dr
Osage Beach, MO 65065
Phone (573) 280-2772

Interoperability endpoints

  • Direct secure messaging: evgeniyabanina@mhccaremail.com
  • Direct secure messaging: lakeregionalcliniceldon@mhccaremail.com

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 5

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": "1460592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562630400000",
    "number": "1205280427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 W 5TH ST",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797634206",
            "telephone_number": "432-703-5375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304A E 4TH ST",
            "city": "ELDON",
            "state": "MO",
            "postal_code": "65026",
            "telephone_number": "573-392-5654",
            "fax_number": "573-392-5692"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 W 5th St",
            "address_purpose": "LOCATION",
            "city": "Odessa",
            "state": "TX",
            "postal_code": "797634206",
            "country_code": "US",
            "telephone_number": "432-703-5375",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2333 Highway 17",
            "address_purpose": "LOCATION",
            "city": "Iberia",
            "state": "MO",
            "postal_code": "654869331",
            "country_code": "US",
            "telephone_number": "573-793-6900",
            "fax_number": "573-793-6688",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANINA",
        "first_name": "EVGENIYA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-14",
        "last_updated": "2019-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2019024533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eldon, MO

Sources for this page

Verify at the official NPI Registry.