NPIMap

Individual provider Active NPI

Myra June Watson, D.O.

  • Nephrology Physician
  • Columbia, MO
National Provider Identifier
1366448425
Registry record updated Apr 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
108840 Issued in MO
Practice address
1205 W Broadway
Columbia, MO 65203-2125
Phone
(573) 499-0642
Fax
(573) 449-1787
NPI assigned
Jun 23, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 108840 MO Primary

Addresses

Primary practice location

1205 W Broadway
Columbia, MO 65203-2125

Mailing address

1205 W Broadway
Columbia, MO 65203-2125
Phone (573) 499-0642

Other identifiers 10

IdentifierTypeStateIssuer
G99626OtherMOMERCY
1911260OtherMOFIRST HEALTH
143430OtherMOBLUE CROSS BLUE SHIELD
7329520OtherMOAETNA
458323OtherMOHEALTHLINK
000623655OtherMOHUMANA
3100096OtherMOUNITED HEALTHCARE
390007475OtherMORAILROAD MEDICARE
17496OtherMOHEALTHCARE USA
245327309MedicaidMO

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
I20080917000284 MO Practitioner - NephrologyPractitioner - Internal Medicine 0749274397 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nephrology and Hypertension AssociatesGroup PAC ID 9830182534, 7 clinicians

Practice addresses (Care Compare)

1205 W Broadway
Columbia, MO 65203-2125
Phone (573) 499-0642

600 Rosewood Dr
Kirksville, MO 63501-2477
Phone (573) 499-0642

Hospital & facility affiliations

  • Dialysis Clinics, Inc - Kirksville Dialysis facility, Kirksville, MO, CCN 262505
  • Dialysis Clinics, Inc - Mexico Dialysis facility, Mexico, MO, CCN 262516
  • DaVita RTC-Columbia Dialysis Dialysis facility, Columbia, MO, CCN 262611
  • Dialysis Clinics, Inc - Columbia Dialysis facility, Columbia, MO, CCN 262506
  • Dialysis Clinics, Inc. - Macon Dialysis facility, Macon, MO, CCN 262671
  • Elara Caring Home health agency, Jefferson City, MO, CCN 267600
  • Boone Hospital Center Hospital, Columbia, MO, CCN 260068
  • Macon County Samaritan Memorial Hospital Hospital, Macon, MO, CCN 261313
  • Northeast Regional Medical Center Hospital, Kirksville, MO, CCN 260022
  • Scotland County Hospital Hospital, Memphis, MO, CCN 261310
  • Sullivan County Memorial Hospital Hospital, Milan, MO, CCN 261306

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
108840MOMDNephrology Physician

Interoperability endpoints

  • Direct secure messaging: mjwatson@nhacolumbia.ssdirect.aprima.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

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": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397001600000",
    "number": "1366448425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 W BROADWAY",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652032125",
            "telephone_number": "573-499-0642",
            "fax_number": "573-449-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 W BROADWAY",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652032125",
            "telephone_number": "573-499-0642",
            "fax_number": "573-449-1787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "MYRA",
        "middle_name": "JUNE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-23",
        "last_updated": "2014-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MO",
            "license": "108840",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY",
            "identifier": "G99626",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "1911260",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "143430",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7329520",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "458323",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "000623655",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "3100096",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "390007475",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHCARE USA",
            "identifier": "17496",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "245327309",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.