Connie Lynn Butler, MD – Family Medicine Physician

Key facts

NPI: 1255412417
Entity type: Individual (NPI type 1)
Primary specialty: Family Medicine Physician 207Q00000X
License: 2005014673 (MO)
Practice address: 92 Main St
Cassville, MO 65625-1610
Phone: (417) 847-5225
Fax: (417) 847-5425
NPI assigned: Oct 17, 2006
Sex: Female
Sole proprietor: No

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.

Mercy Clinic Springfield Communities Rural Health Clinic/Center · Willow Springs, MO · NPI 1972771657

Medicare reassignment MO
Mercy Clinic Springfield Communities Durable Medical Equipment & Medical Supplies · Rolla, MO · NPI 1023215571

NPD
Circle of Life Community Based Hospice Care Agency · Springdale, AR · NPI 1386755460

NPD FAMILY MEDICINE

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Circle of Life Community Based Hospice Care Agency · Springdale, AR · NPI 1386755460

CMS ownership W-2 MANAGING EMPLOYEE

Medicare participation

Medicare fee-for-service enrollment: Enrolled (2 enrollments) in MO, AR
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Facility	Type	Role	Since
Circle of Life Springdale, AR · CCN 041529	Hospice	W-2 Managing Employee	Aug 1, 2023

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20050820000013	MO	Practitioner - Family Practice	4284610296	Reassigns benefits to 1 organization
I20230815001781	AR	Practitioner - Family Practice	4284610296

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
2005014673	MO	MD	Family Medicine Physician

Practice roles

Organization	Specialty	Status	New patients
Mercy Clinic Springfield Communities		Current since Aug 1, 2005	Accepting new patients
Circle of Life	Family Medicine	Current since May 17, 2023	Accepting new patients

Locations

901 Jones Rd
Springdale, AR 72762
Phone (479) 750-6632

Interoperability endpoints

Direct secure messaging: cbutler77@directb.mercy.net

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician	207Q00000X	2005014673	MO	Yes

Addresses

Primary practice location

92 Main St
Cassville, MO 65625-1610

Mailing address

92 Main St
Cassville, MO 65625-1610
Phone (417) 847-5225

Other identifiers

Identifier	Type	State	Issuer
207415605	Medicaid	MO

Other providers in Cassville, MO

All providers in Cassville, MO · Family Medicine Physician in Missouri

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
Provider of Services files (CMS): certification status, beds and related CCNs.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.