Active NPI
Anthony B Pendergrass, ED.D., LPC
- Counselor
- Piedmont, MO
National Provider Identifier
1376680694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 2006038843
- Practice address
- 306 N 2ND St
Piedmont, MO 63957-1301 - Phone
- (573) 223-7649
- Fax
- (573) 223-7691
- NPI assigned
- Jan 30, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 2006038843 | MO | Primary |
Addresses
Primary practice location
306 N 2ND St
Piedmont, MO 63957-1301
Mailing address
RR 1 Box 1309
Piedmont, MO 63957-9715
Phone (573) 223-3685
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2006038843 | MO | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Counseling Center, Inc. | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba FCC Primary Care
- Primary Care Clinic/Center
- Poplar Bluff, MO
- NPI 1235738493
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376680694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "RR 1 BOX 1309",
"city": "PIEDMONT",
"state": "MO",
"postal_code": "639579715",
"telephone_number": "573-223-3685",
"fax_number": "573-223-7691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 N 2ND ST",
"city": "PIEDMONT",
"state": "MO",
"postal_code": "639571301",
"telephone_number": "573-223-7649",
"fax_number": "573-223-7691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDERGRASS",
"first_name": "ANTHONY",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "ED.D., LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MO",
"license": "2006038843",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Piedmont, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.