Individual provider Active NPI

Wayne Earl Davis, DO

  • Ophthalmology Physician
  • Columbia, MO
National Provider Identifier
1265663017
Registry record updated Apr 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
2015006386 Issued in MO
Practice address
3600 Amron CT
Columbia, MO 65202-1918
Phone
(573) 874-1616
Fax
(573) 875-0300
NPI assigned
Jul 28, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 10, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Retina Specialist (Ophthalmology) Physician 207WX0107X 2015006386 MO
Ophthalmology Physician 207W00000X 2015006386 MO Primary

Addresses

Primary practice location

3600 Amron CT
Columbia, MO 65202-1918

Mailing address

3600 Amron CT
Columbia, MO 65202-1918
Phone (573) 874-1616

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150616000273 MO Practitioner - Ophthalmology 9032352182 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Retina Associates of Missouri PCGroup PAC ID 6507924263, 2 clinicians

Practice addresses (Care Compare)

3600 Amron CT
Columbia, MO 65202-1918
Phone (573) 874-1616

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.72 of 100Reported as group
Quality
97.43
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2015006386MOMDRetina Specialist (Ophthalmology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Retina Associates of Missouri, P.C. Ophthalmology CurrentSince Aug 3, 2015 Accepting new patients
Columbia Orthopaedic Group, LLP Past Accepting new patients

Locations

3600 Amron Ct
Columbia, MO 65202
Phone (573) 874-1616

1904 N Baltimore St
Kirksville, MO 63501
Phone (660) 665-3564

321 W Promenade St
Mexico, MO 65265
Phone (573) 581-8811

5962 Osage Beach Pkwy
Osage Beach, MO 65065
Phone (573) 348-2747

Organizations & group practices 2

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 2

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": "1248739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491782400000",
    "number": "1265663017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 AMRON CT",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652021918",
            "telephone_number": "573-874-1616",
            "fax_number": "573-875-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 AMRON CT",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652021918",
            "telephone_number": "573-874-1616",
            "fax_number": "573-875-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "WAYNE",
        "middle_name": "EARL",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-28",
        "last_updated": "2017-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "MO",
            "license": "2015006386",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MO",
            "license": "2015006386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.