Individual provider Active NPI

Molly J Omohundro, APRN

  • Family Nurse Practitioner
  • Jefferson City, MO
National Provider Identifier
1366956963
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2017043235 Issued in MO
Practice address
3605 Country Club Dr
Jefferson City, MO 65109-1070
Phone
(573) 634-4878
Fax
(573) 636-3045
NPI assigned
Nov 20, 2017
Last updated
Jun 28, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2017043235 MO Primary

Addresses

Primary practice location

3605 Country Club Dr
Jefferson City, MO 65109-1070

Mailing address

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

Other practice location 1

One Hospital Dr
Columbia, MO 65212-0001
Phone (573) 882-8091

Other identifiers 1

IdentifierTypeStateIssuer
420050202MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180129000027 MO Practitioner - Nurse Practitioner 4981964608 Reassigns benefits to 2 organizations
I20190221001034 KS Practitioner - Nurse Practitioner 4981964608 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
80.23 of 100Reported as group
Quality
58.17
Promoting interoperability
100
Improvement activities
40
Cost
75.92

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2017043235MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Curators of the University of Missouri CurrentSince Jun 8, 2022 Accepting new patients
Liberty Hospital Emergency Medicine Physicians, LLC CurrentSince Jul 1, 2018 Accepting new patients
Curators of the University of Missouri CurrentSince Jun 8, 2022 Accepting new patients
Shawnee Mission Medical Center, Inc. CurrentSince Feb 4, 2019 Accepting new patients
Shawnee Mission Medical Center, Inc. CurrentSince Feb 4, 2019 Accepting new patients
New Liberty Hospital Coporation PastSince Nov 17, 2024 Accepting new patients

Locations

7315 E Frontage Rd
Ste 202
Merriam, KS 66204

1 Hospital Dr
Columbia, MO 65212
Phone (573) 882-2568

404 N Keene St
Columbia, MO 65201
Phone (573) 875-9000

1241 W Stadium Blvd
Jefferson Cty, MO 65109
Phone (573) 556-5771

2525 Glenn Hendren Dr
Liberty, MO 64068
Phone (816) 781-7200

Organizations & group practices 6

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": "1511136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1366956963",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3605 COUNTRY CLUB DR",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651091070",
            "telephone_number": "573-634-4878",
            "fax_number": "573-636-3045"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "One Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652120001",
            "country_code": "US",
            "telephone_number": "573-882-8091",
            "fax_number": "573-884-1902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OMOHUNDRO",
        "first_name": "MOLLY",
        "middle_name": "J",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-20",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2017043235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420050202",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson City, MO

Sources for this page

Verify at the official NPI Registry.