NPIMap

Individual provider Active NPI

Joan Marie Dutton, ACNP-BC

  • Acute Care Nurse Practitioner
  • Carthage, MO
National Provider Identifier
1336494319
Registry record updated Mar 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
2012022610 Issued in MO
Practice address
3125 Dr Russell Smith Way
Carthage, MO 64836-7402
Phone
(417) 825-1718
NPI assigned
Jul 17, 2012
Last updated
Mar 17, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 2012022610 MO Primary

Addresses

Primary practice location

3125 Dr Russell Smith Way
Carthage, MO 64836-7402

Mailing address

3125 Dr Russell Smith Way
Carthage, MO 64836-7402
Phone (417) 825-1718

Other identifiers 4

IdentifierTypeStateIssuer
200878470AMedicaidKS
P01134665OtherMORAIL ROAD MEDICARE
200464730AMedicaidOK
1336494319MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121003000890 MO Practitioner - Nurse Practitioner 1355590571 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Joplin LLCGroup PAC ID 0547300196, 288 clinicians

Practice addresses (Care Compare)

100 Mercy Way
Joplin, MO 64804-4524

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2012022610MOMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Hospices of America, LLC CurrentSince Apr 21, 2023 Accepting new patients
Mercy Clinic Joplin LLC CurrentSince Jul 23, 2012 Accepting new patients
Community Hospices of America, LLC Current Accepting new patients
Community Hospices of America LLC CurrentSince Apr 21, 2023 Accepting new patients

Locations

3125 Dr Russell Smith Way
Carthage, MO 64836
Phone (417) 358-8121

94 Main St
Cassville, MO 65625
Phone (417) 782-7722

100 Mercy Way
Joplin, MO 64804
Phone (417) 556-2300

707 E Briggs Dr
#B
Macon, MO 63552
Phone (660) 385-4400

230 Business Highway 13
Ste 2
Osceola, MO 64776
Phone (417) 283-3244

10 Cadillac Dr
Ste 400
Brentwood, TN 37027
Phone (615) 637-9163

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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": "1342483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458172800000",
    "number": "1336494319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3125 DR RUSSELL SMITH WAY",
            "city": "CARTHAGE",
            "state": "MO",
            "postal_code": "648367402",
            "telephone_number": "417-825-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3125 DR RUSSELL SMITH WAY",
            "city": "CARTHAGE",
            "state": "MO",
            "postal_code": "648367402",
            "telephone_number": "417-825-1718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUTTON",
        "first_name": "JOAN",
        "middle_name": "MARIE",
        "credential": "ACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-17",
        "last_updated": "2016-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MO",
            "license": "2012022610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200878470A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P01134665",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200464730A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336494319",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carthage, MO

Sources for this page

Verify at the official NPI Registry.