John Franklin Niswonger, AGNP-C

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

2020034604 Issued in MO

Practice address

861 Canyon TRL
Jackson, MO 63755-4001

Phone

(573) 837-2390

NPI assigned

Oct 28, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Johnny Franklin Niswonger Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeast Missouri Hospital Physicians LLCGroup PAC ID 9133024334, 206 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Southeast Hospital, Cape Girardeau, MO, CCN 260110

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southeast Missouri Hospital Physicians, LLC

  • Family Medicine Physician
  • Cape Girardeau, MO
  • NPI 1558311522
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Southeast Hospital

  • General Acute Care Hospital
  • Cape Girardeau, MO
  • NPI 1811006661
  Care Compare affiliation

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

{
    "created_epoch": "1603843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1215537220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "861 CANYON TRL",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637554001",
            "telephone_number": "573-837-2390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "861 CANYON TRL",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637554001",
            "telephone_number": "573-837-2390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISWONGER",
        "first_name": "JOHN",
        "middle_name": "FRANKLIN",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-28",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2020034604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "nise1gr@gmail.com",
            "affiliation": "N",
            "address_1": "861 Canyon Trl",
            "city": "Jackson",
            "state": "MO",
            "country_code": "US",
            "postal_code": "637554001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JOHNNY",
            "last_name": "NISWONGER",
            "middle_name": "FRANKLIN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Amanda Niehaus
• Jamie Rosanne Nipper, OTR/L
• Candice O'Hare, MS, RD
• Emily Jo Obergoenner, M.A., SLP
• Lori Obermann
• Franklin Jeremy Pace, ATC
• Pain Relief Clinic LLC

• Adult Health Nurse Practitioner in Jackson, MO
• Providers in Jackson, MO by specialty
• Adult Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.