NPIMap

Individual provider Active NPI

Jordan Adair Palmer, DO

  • Family Medicine Physician
  • Kirksville, MO
National Provider Identifier
1245760495
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2019011044 Issued in MO
Practice address
1611 S Baltimore St
Kirksville, MO 63501-4518
Phone
(660) 665-7575
Fax
(660) 665-7576
NPI assigned
Jun 19, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 12326A WY
Addiction Medicine (Family Medicine) Physician 207QA0401X 2019011044 MO
Family Medicine Physician 207Q00000X 2019011044 MO Primary

Addresses

Primary practice location

1611 S Baltimore St
Kirksville, MO 63501-4518

Mailing address

1611 S Baltimore St
Kirksville, MO 63501-4518
Phone (660) 665-7575

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200716000866 MO Practitioner - Family Practice 8527318484 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 E Normal Ave
Kirksville, MO 63501-4200
Phone (660) 785-4011

1605 S Baltimore St
Kirksville, MO 63501-4508
Phone (660) 665-3599

1611 S Baltimore St
Kirksville, MO 63501-4518
Phone (660) 665-7575

624 W Lockling St
Brookfield, MO 64628-2003
Phone (660) 268-4006

6500 Hospital Dr
Hannibal, MO 63401-6890
Phone (573) 248-1300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions19
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2019011044MOMDFamily Medicine Physician
12326AWYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hannibal Regional Healthcare System Inc CurrentSince Jul 27, 2020 Accepting new patients
Hannibal Regional Healthcare System, Inc Current Accepting new patients
Hannibal Regional Healthcare System, Inc Family Medicine CurrentSince Jul 27, 2020 Accepting new patients

Locations

6500 Hospital Dr
Hannibal, MO 63401
Phone (573) 629-3400

1611 S Baltimore St
Kirksville, MO 63501
Phone (660) 372-9595

1611 S Baltimore St
#A
Kirksville, MO 63501

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10040602
  • Direct secure messaging: jordan.palmerdo.p1@direct.cfmkv.nextgenshare.com

Organizations & group practices 3

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.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1497830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1245760495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 S BALTIMORE ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635014518",
            "telephone_number": "660-665-7575",
            "fax_number": "660-665-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 S BALTIMORE ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635014518",
            "telephone_number": "660-665-7575",
            "fax_number": "660-665-7576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALMER",
        "first_name": "JORDAN",
        "middle_name": "ADAIR",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-19",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WY",
            "license": "12326A",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "MO",
            "license": "2019011044",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2019011044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirksville, MO

Sources for this page

Verify at the official NPI Registry.