Kirksville Specialty Clinic LLC

Primary specialty

Rheumatology PhysicianTaxonomy code 207RR0500X

License

R6C73 Issued in MO

Legal business name

KIRKSVILLE SPECIALTY CLINIC LLC

Practice address

1108 E Patterson St Ste 10
Kirksville, MO 63501-4043

Phone

(660) 956-0487

Fax

(660) 956-0446

NPI assigned

Sep 6, 2018

Last updated

Feb 11, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. David Neuendorf

Title

Ceo

Phone

(573) 886-8904

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 6

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.

• Lawrence Lester Ciesemier, D.O

  • Allergy & Immunology (Internal Medicine) Physician
  • Kirksville, MO
  • NPI 1952464190
  Medicare reassignment
• Heather Jo Evans, MSN, FNP-C

  • Family Nurse Practitioner
  • Brookfield, MO
  • NPI 1700513538
  Medicare reassignment
• Robert Wayne Jackson, D.O.

  • Rheumatology Physician
  • Memphis, MO
  • NPI 1730293705
  Medicare reassignment
• Tonia Marieannette Nerini, NP-C

  • Gerontology Nurse Practitioner
  • Bevier, MO
  • NPI 1790220606
  Medicare reassignment
• Shayla Sanders, FNP-BC

  • Family Nurse Practitioner
  • Kansas City, MO
  • NPI 1841607900
  Medicare reassignment
• Tracy Novinger, APRN

  • Family Nurse Practitioner
  • Kirksville, MO
  • NPI 1124918321
  NPD

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

{
    "created_epoch": "1536192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581379200000",
    "number": "1386126308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 E PATTERSON ST STE 10",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635014043",
            "telephone_number": "660-956-0487",
            "fax_number": "660-956-0446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 E PATTERSON ST STE 10",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635014043",
            "telephone_number": "660-956-0487",
            "fax_number": "660-956-0446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIRKSVILLE SPECIALTY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-06",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "status": "A",
        "authorized_official_last_name": "NEUENDORF",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-886-8904",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "MO",
            "license": "R6C73",
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kirksville Residential, LLC (Highland Crest Memory Care)
• Kirksville Speech and Swallow Clinic LLC
• Jonathon R Kirsch, D.O.
• John R Knudsen, DO
• Brandon Koester
• Dave Darko Kojic, DMD, MS, PHD

• Rheumatology Physician in Kirksville, MO
• Providers in Kirksville, MO by specialty
• Rheumatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2020; 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.