Active NPI
Moberly Hospital Company LLC
- Emergency Medicine Physician
- Moberly, MO
National Provider Identifier
1205967486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- Legal business name
- MOBERLY HOSPITAL COMPANY LLC
- Practice address
- 1515 Union Ave
Moberly, MO 65270-9407 - Phone
- (660) 263-8400
- Fax
- (660) 269-3091
- NPI assigned
- Mar 8, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Debbie Brewer
- Title
- Director
- Phone
- (877) 892-9813
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | MO | Primary |
Addresses
Primary practice location
1515 Union Ave
Moberly, MO 65270-9407
Mailing address
PO Box 504460
Saint Louis, MO 63150-0001
Phone (800) 819-2547
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 116134 | Other | MO | ANTHEM BCBS |
| 541435004 | Medicaid | MO |
Other names 1
- Emergency Department
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070517000099 | MO | Part B Supplier - Clinic/Group Practice | 9436052230 |
Receives reassigned benefits from 10 practitioners 3 other NPIs on this enrollment Practice locations: Madison, MO; Salisbury, MO; Moberly, MO |
Other NPIs with the same Medicare PAC ID 5
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- Medicare Defined Swing Bed Hospital Unit
- Moberly, MO
- NPI 1346212784
9436052230
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryMember organizations 3
Organizations listed as members of this organization in the National Provider Directory.
Practitioners & affiliated clinicians
Practitioners 10
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1205967486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 504460",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631500001",
"telephone_number": "800-819-2547",
"fax_number": "423-296-6006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1515 UNION AVE",
"city": "MOBERLY",
"state": "MO",
"postal_code": "652709407",
"telephone_number": "660-263-8400",
"fax_number": "660-269-3091"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOBERLY HOSPITAL COMPANY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-08",
"last_updated": "2022-07-21",
"status": "A",
"authorized_official_last_name": "BREWER",
"authorized_official_first_name": "DEBBIE",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "877-892-9813"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Emergency Medicine",
"state": "MO",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "116134",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "541435004",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Emergency Department",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Moberly, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.