NPIMap

Individual provider Active NPI

Jessica E. Boggs, ANP-C

  • Adult Health Nurse Practitioner
  • Springfield, MO
National Provider Identifier
1255704599
Registry record updated Jan 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
2015034077 Issued in MO
Practice address
1100 E Montclair St
Springfield, MO 65807-5076
Phone
(417) 820-8500
Fax
(417) 820-8532
NPI assigned
Nov 9, 2015
Last updated
Jan 18, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 2015034077 MO Primary

Addresses

Primary practice location

1100 E Montclair St
Springfield, MO 65807-5076

Mailing address

PO Box 505164
Saint Louis, MO 63150-5164
Phone (417) 829-4620

Other identifiers 1

IdentifierTypeStateIssuer
1255704599MedicaidMO

Other names 1

  • Jessica E. Blaha Former name

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
I20160114002903 MO Practitioner - Nurse Practitioner 3274836838 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

1235 E Cherokee St
Springfield, MO 65804-2203
Phone (417) 820-2600

448 State Hwy 248
Suite 160
Branson, MO 65616-3725
Phone (417) 213-4696

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2015034077MOMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Feb 6, 2019 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jan 1, 2016 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jan 1, 2016 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

448 State Highway 248
Ste 160
Branson, MO 65616
Phone (417) 213-4696

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

1100 E Montclair St
Springfield, MO 65807
Phone (417) 820-8500

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

Interoperability endpoints

  • Direct secure messaging: jboggs9384@directc.mercy.net

Organizations & group practices 4

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

Hospital & facility affiliations 9

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": "1447027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453075200000",
    "number": "1255704599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 505164",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631505164",
            "telephone_number": "417-829-4620",
            "fax_number": "417-829-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E MONTCLAIR ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658075076",
            "telephone_number": "417-820-8500",
            "fax_number": "417-820-8532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGGS",
        "first_name": "JESSICA",
        "middle_name": "E.",
        "credential": "ANP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-09",
        "last_updated": "2016-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2015034077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255704599",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "BLAHA",
            "middle_name": "E.",
            "credential": "ANP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.