Sally J Ellebracht-Gerke, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2001014617 Issued in MO

Practice address

17110 Highway 87
Boonville, MO 65233-2939

Phone

(660) 672-7005

Fax

(660) 882-3147

NPI assigned

Jul 2, 2006

Last updated

Apr 18, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Previously, effective Oct 1, 2012 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366243200000",
    "number": "1235168097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17110 HIGHWAY 87",
            "city": "BOONVILLE",
            "state": "MO",
            "postal_code": "652332939",
            "telephone_number": "660-672-7005",
            "fax_number": "660-882-3147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17110 HIGHWAY 87",
            "city": "BOONVILLE",
            "state": "MO",
            "postal_code": "652332939",
            "telephone_number": "660-672-7005",
            "fax_number": "660-882-3147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLEBRACHT-GERKE",
        "first_name": "SALLY",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-02",
        "last_updated": "2013-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2001014617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209200401",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Boonville, MO
• Providers in Boonville, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2013; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.