NPIMap

Organization Active NPI

Jefferson City Medical Group, P.C.

  • Multi-Specialty Clinic/Center
  • Jefferson City, MO
National Provider Identifier
1336189398
Registry record updated Jun 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
JEFFERSON CITY MEDICAL GROUP, P.C.
Practice address
1241 W Stadium Blvd
First Floor, Suite 1100
Jefferson City, MO 65109
Phone
(573) 556-5747
Fax
(573) 636-9756
NPI assigned
Jun 7, 2006
Last updated
Jun 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2023

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

Authorized official

Name
Jeffrey Patrick, MDNPI 1316910904
Title
President
Phone
(573) 635-5264

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
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

1241 W Stadium Blvd
First Floor, Suite 1100
Jefferson City, MO 65109

Mailing address

PO Box 104240
Jefferson City, MO 65110-4240
Phone (573) 635-5264

Other identifiers 5

IdentifierTypeStateIssuer
CD6058OtherMOMEDICARE RAILROAD
CC7852OtherMOMEDICARE RAILROAD
CD6060OtherMOMEDICARE RAILROAD
CD6059OtherMOMEDICARE RAILROAD
CD6061OtherMOMEDICARE RAILROAD

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040908000924 MO Part B Supplier - Clinic/Group Practice 1850371089 Receives reassigned benefits from 153 practitioners
1 other NPI on this enrollment
Practice locations: Columbia, MO; Sedalia, MO; Osage Beach, MO; Mexico, MO; Marshall, MO; Linn, MO; Jefferson Cty, MO; Jefferson City, MO…

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1225 W Stadium Blvd
Jefferson Cty, MO 65109
Phone (573) 556-7725

1241 W Stadium Blvd
Ste 1100
Jefferson Cty, MO 65109
Phone (573) 556-5747

1306 E Main St
Linn, MO 65051
Phone (573) 897-2202

Practitioners & affiliated clinicians

Practitioners 174

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 174

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1336189398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 104240",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651104240",
            "telephone_number": "573-635-5264",
            "fax_number": "573-636-9756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 W STADIUM BLVD",
            "address_2": "FIRST FLOOR, SUITE 1100",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "65109",
            "telephone_number": "573-556-5747",
            "fax_number": "573-636-9756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON CITY MEDICAL GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A",
        "authorized_official_last_name": "PATRICK",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-635-5264",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CD6058",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CC7852",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CD6060",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CD6059",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CD6061",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.1",
            "affiliationName": "Bluemark LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "40 Sunset Ridge Rd Ste 120",
            "city": "New Paltz",
            "state": "NY",
            "country_code": "US",
            "postal_code": "125611039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jefferson City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; 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.