Active NPI
Juan Jose Pineda, M.D.
- Gastroenterology Physician
- Columbia, MO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- R3P42
- Practice address
- 3300 Vawter School Rd
Columbia, MO 65203-8609 - Phone
- (573) 445-9764
- NPI assigned
- Jun 21, 2005
- Last updated
- Aug 15, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | R3P42 | MO | |
| Gastroenterology Physician | 207RG0100X | R3P42 | MO | Primary |
Addresses
Primary practice location
3300 Vawter School Rd
Columbia, MO 65203-8609
Mailing address
3300 Vawter School Rd
Columbia, MO 65203-8609
Phone (573) 445-9764
Other practice location 1
965 Mattox Dr
Sullivan, MO 63080-2365
Phone (573) 860-6000
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 206996613 | Medicaid | MO | |
| 6520 | Other | MO | BLUE CROSS/BLUE SHIELD/MO |
| 110212405 | Other | MO | RAILROAD MEDICARE |
| 251779 | Other | MO | HEALTHLINK |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO, FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Gastroenterology
- Education
- Other, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
508 E Garden St
Lakeland, FL 33805-4616
Phone (863) 802-1111
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 11 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R3P42 | MO | MD | Gastroenterology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Missouri Baptist Hospital of Sullivan | Current | Accepting new patients | |
| Missouri Baptist Hospital of Sullivan | Current | Accepting new patients | |
| Digestive Diseases Care for All LLC | Internal Medicine | Current | Accepting new patients |
| Missouri Baptist Hospital of Sullivan | Current | Accepting new patients | |
| Comprehensive Psychiatric Associates LLC | Past | Accepting new patients |
Locations
508 E Garden St
Lakeland, FL 33805
Phone (813) 688-2447
965 Mattox Dr
Sullivan, MO 63080
Phone (573) 468-7054
Interoperability endpoints
- https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
- jpineda14597@direct.carenet.org
Organizations & group practices 5
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.
-
- Gastroenterology Physician
- Lakeland, FL
- NPI 1346484565
Internal Medicine
-
- Critical Access Hospital
- Sullivan, MO
- NPI 1295743169
-
dba Sullivan Medical Office
- Rural Health Clinic/Center
- Sullivan, MO
- NPI 1235228222
-
dba Missouri Baptist Sullivan Hospital
- Ambulance
- Sullivan, MO
- NPI 1831343268
-
- Psychiatry Physician
- Lakeland, FL
- NPI 1457714834
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660521600000",
"number": "1386649812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3300 VAWTER SCHOOL RD",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652038609",
"telephone_number": "573-445-9764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3300 VAWTER SCHOOL RD",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652038609",
"telephone_number": "573-445-9764"
}
],
"practiceLocations": [
{
"address_1": "965 Mattox Dr",
"address_purpose": "LOCATION",
"city": "Sullivan",
"state": "MO",
"postal_code": "630802365",
"country_code": "US",
"telephone_number": "573-860-6000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PINEDA",
"first_name": "JUAN",
"middle_name": "JOSE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-21",
"last_updated": "2022-08-15",
"certification_date": "2022-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MO",
"license": "R3P42",
"primary": false
},
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "MO",
"license": "R3P42",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "206996613",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD/MO",
"identifier": "6520",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "110212405",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "251779",
"state": "MO"
}
],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
"affiliation": "N",
"endpointDescription": "BJC",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "965 Mattox Dr",
"city": "Sullivan",
"state": "MO",
"country_code": "US",
"postal_code": "630802365",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.