NPIMap

Organization Active NPI

Heartland Weight Loss Clinic, LLC

  • Medical Specialty Clinic/Center
  • Cape Girardeau, MO
National Provider Identifier
1215536818
Registry record updated Apr 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
HEARTLAND WEIGHT LOSS CLINIC, LLC
Practice address
3095 Lexington Ave Ste 200
Cape Girardeau, MO 63701-2629
Phone
(573) 803-2287
NPI assigned
Oct 23, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2023

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

Authorized official

Name
Ryan A Legrand, MDNPI 1568591329
Title
Physician
Phone
(573) 803-2287

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

3095 Lexington Ave Ste 200
Cape Girardeau, MO 63701-2629

Mailing address

3095 Lexington Ave Ste 200
Cape Girardeau, MO 63701-2629
Phone (573) 803-2287

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201207000796 MO Part B Supplier - Clinic/Group Practice 7113339607 Receives reassigned benefits from 7 practitioners
Practice locations: Cape Girardeau, MO

National Provider Directory

National Provider Directory

Locations

64 Doctors Park
Cpe Girardeau, MO 63703
Phone (573) 334-5265

Practitioners & affiliated clinicians

Practitioners 7

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": "1603411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680739200000",
    "number": "1215536818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3095 LEXINGTON AVE STE 200",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637012629",
            "telephone_number": "573-803-2287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3095 LEXINGTON AVE STE 200",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637012629",
            "telephone_number": "573-803-2287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND WEIGHT LOSS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-23",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A",
        "authorized_official_last_name": "LEGRAND",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "573-803-2287",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Girardeau, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; 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.