NPIMap

Organization Active NPI

Mercy Clinic Springfield Communities

Doing business as Mercy Clinic-Agape Family Medicine

  • Rural Health Clinic/Center
  • Lebanon, MO
National Provider Identifier
1215066956
Registry record updated Dec 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY CLINIC SPRINGFIELD COMMUNITIES
Doing business as
Mercy Clinic-Agape Family Medicine
Practice address
331 Hospital Dr
Suite C
Lebanon, MO 65536
Phone
(417) 533-6500
Fax
(417) 533-6555
NPI assigned
Mar 5, 2007
Last updated
Dec 4, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2018

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

Authorized official

Name
Dr. Robert Cavagnol
Title
Chief Physician Officer
Phone
(417) 820-2705

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X MO Primary
Physician Assistant 363A00000X 2002018364 MO
Family Medicine Physician 207Q00000X 105131 MO

Addresses

Primary practice location

331 Hospital Dr
Suite C
Lebanon, MO 65536

Mailing address

645 Maryville Centre Dr FL 3
Saint Louis, MO 63141-5855
Phone (417) 820-7133

Other identifiers 1

IdentifierTypeStateIssuer
595979907MedicaidMO

Other names 1

  • Mercy Clinic-Agape Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031218000354 MO Part B Supplier - Clinic/Group Practice 7416865845 Receives reassigned benefits from 1,639 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 29

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 29

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543881600000",
    "number": "1215066956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 MARYVILLE CENTRE DR FL 3",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415855",
            "telephone_number": "417-820-7133",
            "fax_number": "417-820-0586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 HOSPITAL DR",
            "address_2": "SUITE C",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "65536",
            "telephone_number": "417-533-6500",
            "fax_number": "417-533-6555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY CLINIC SPRINGFIELD COMMUNITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2018-12-04",
        "status": "A",
        "authorized_official_last_name": "CAVAGNOL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF PHYSICIAN OFFICER",
        "authorized_official_telephone_number": "417-820-2705",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2002018364",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "105131",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "595979907",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Clinic-Agape Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Clinic-Agape Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2018; 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.

Verify at the official NPI Registry.