NPIMap

Individual provider Active NPI

Jeffrey Richard Fenwick, MD

  • Otolaryngology Physician
  • Springfield, MO
National Provider Identifier
1306846407
Registry record updated Dec 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
2005041177 Issued in MO
Practice address
960 E Walnut Lawn St
Suite 102
Springfield, MO 65807-7506
Phone
(417) 875-3600
Fax
(417) 875-3612
NPI assigned
Jul 29, 2005
Last updated
Dec 27, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 15294 SC
Otolaryngology Physician 207Y00000X 2005041177 MO Primary

Addresses

Primary practice location

960 E Walnut Lawn St
Suite 102
Springfield, MO 65807-7506

Mailing address

960 E Walnut Lawn St
Suite 102
Springfield, MO 65807-7506
Phone (417) 875-3000

Other identifiers 2

IdentifierTypeStateIssuer
200282606MedicaidMO
152998MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Harvard Medical School, 1985
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

P O Box
Suite 9007
Springfield, MO 65808-9007

PO Box
Suite 9007
Springfield, MO 65808

Merit-based Incentive Payment System (MIPS)

Final score
82.25 of 100Reported as group
Quality
64.73
Promoting interoperability
100
Improvement activities
40
Cost
76.1

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2005041177MOMDOtolaryngology Physician
15294SCMDOtolaryngology Physician
15299SCMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Carolina Sleep Medicine LLC Otolaryngology Past Accepting new patients
Summerville Sleep Consultants LLC PastSince May 5, 2003 Accepting new patients
Ferrell Duncan Clinic, Inc Past Accepting new patients
Low Country ENT PA Otolaryngology PastSince Oct 1, 2008 Accepting new patients
Ozarks Medical Center Otolaryngology Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: jeffrey.fenwick@cernerdirect.coxhealth.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545868800000",
    "number": "1306846407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 E WALNUT LAWN ST",
            "address_2": "SUITE 102",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658077506",
            "telephone_number": "417-875-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 E WALNUT LAWN ST",
            "address_2": "SUITE 102",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658077506",
            "telephone_number": "417-875-3600",
            "fax_number": "417-875-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENWICK",
        "first_name": "JEFFREY",
        "middle_name": "RICHARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-29",
        "last_updated": "2018-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "SC",
            "license": "15294",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MO",
            "license": "2005041177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200282606",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152998",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.