NPIMap

Organization Active NPI

Ozark Gastroenterology, Inc

  • Gastroenterology Physician
  • Joplin, MO
National Provider Identifier
1295985968
Registry record updated Apr 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
2005009627 Issued in MO
Legal business name
OZARK GASTROENTEROLOGY, INC
Practice address
2216 E 32ND Street
Ste 103
Joplin, MO 64804
Phone
(417) 623-5250
Fax
(417) 623-8302
NPI assigned
Sep 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2014

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

Authorized official

Name
Dr. Sudhakar Ancha, MDNPI 1346395852
Title
Owner
Phone
(417) 623-5250

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X 2005009627 MO Primary

Addresses

Primary practice location

2216 E 32ND Street
Ste 103
Joplin, MO 64804

Mailing address

2216 E 32ND Street
Ste 103
Joplin, MO 64804
Phone (417) 623-5250

Other identifiers 2

IdentifierTypeStateIssuer
000093116OtherMOMEDICARE P10
1346395852OtherMOINDIVIDUAL NPI

Other names 1

  • SUDHAKAR ANCHA, MD Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081004000070 MO Part B Supplier - Clinic/Group Practice 8224106273 Receives reassigned benefits from 1 practitioner
Practice locations: Joplin, MO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398297600000",
    "number": "1295985968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2216 E 32ND STREET",
            "address_2": "STE 103",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "64804",
            "telephone_number": "417-623-5250",
            "fax_number": "417-623-8302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2216 E 32ND STREET",
            "address_2": "STE 103",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "64804",
            "telephone_number": "417-623-5250",
            "fax_number": "417-623-8302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OZARK GASTROENTEROLOGY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-30",
        "last_updated": "2014-04-24",
        "status": "A",
        "authorized_official_last_name": "ANCHA",
        "authorized_official_first_name": "SUDHAKAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-623-5250",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MO",
            "license": "2005009627",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE P10",
            "identifier": "000093116",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1346395852",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUDHAKAR ANCHA, MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Joplin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.