NPIMap

Organization Active NPI

Kirksville Missouri Hospital Company LLC

Doing business as Northeast Regional Medical Group

  • Family Medicine Physician
  • Kirksville, MO
National Provider Identifier
1336491448
Registry record updated Dec 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KIRKSVILLE MISSOURI HOSPITAL COMPANY LLC
Doing business as
Northeast Regional Medical Group
Practice address
1607 S Baltimore St
Kirksville, MO 63501-4536
Phone
(660) 627-3363
Fax
(660) 627-3367
NPI assigned
Oct 12, 2012
Last updated
Dec 4, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
KIRKSVILLE MISSOURI HOSPITAL COMPANY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 4, 2012

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

Authorized official

Name
Brian Peoples
Title
Vice-President
Phone
(615) 465-7585

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MO Primary
Internal Medicine Physician 207R00000X MO
Cardiovascular Disease Physician 207RC0000X MO
Critical Care Medicine (Internal Medicine) Physician 207RC0200X

Addresses

Primary practice location

1607 S Baltimore St
Kirksville, MO 63501-4536

Mailing address

PO Box 689022
Franklin, TN 37068-9022
Phone (615) 465-7000

Other names 1

  • Northeast Regional Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130312000204 MO Part B Supplier - Clinic/Group Practice 3274517347 Receives reassigned benefits from 8 practitioners
3 other NPIs on this enrollment
Practice locations: Kirksville, MO

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Kirksville Missouri Co LLC5 organizations share this tax ID, including this one
Part of
Kirksville Missouri Co LLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1350000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354579200000",
    "number": "1336491448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "615-465-7000",
            "fax_number": "615-465-3007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1607 S BALTIMORE ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635014536",
            "telephone_number": "660-627-3363",
            "fax_number": "660-627-3367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIRKSVILLE MISSOURI HOSPITAL COMPANY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KIRKSVILLE MISSOURI HOSPITAL COMPANY LLC",
        "enumeration_date": "2012-10-12",
        "last_updated": "2012-12-04",
        "status": "A",
        "authorized_official_last_name": "PEOPLES",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "615-465-7585"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Regional Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirksville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; 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.