Individual provider Active NPI

Juan Jose Pineda, M.D.

  • Gastroenterology Physician
  • Columbia, MO
National Provider Identifier
1386649812
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
R3P42 Issued in MO
Practice address
3300 Vawter School Rd
Columbia, MO 65203-8609
Phone
(573) 445-9764
NPI assigned
Jun 21, 2005
Last updated
Aug 15, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
206996613MedicaidMO
6520OtherMOBLUE CROSS/BLUE SHIELD/MO
110212405OtherMORAILROAD MEDICARE
251779OtherMOHEALTHLINK

Electronic endpoints 1

TypeEndpointUseAffiliation
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, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20041117000399 MO Practitioner - Internal MedicinePractitioner - Gastroenterology 4789643537 Reassigns benefits to 1 organization
I20211104000953 FL Practitioner - Gastroenterology 4789643537 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Digestive Diseases Care for All LLCGroup PAC ID 3870632490, 2 clinicians

Practice addresses (Care Compare)

508 E Garden St
Lakeland, FL 33805-4616
Phone (863) 802-1111

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy11
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R3P42MOMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Missouri Baptist Hospital of Sullivan CurrentSince Sep 1, 2022 Accepting new patients
Missouri Baptist Hospital of Sullivan Current Accepting new patients
Digestive Diseases Care for All LLC Internal Medicine CurrentSince Sep 27, 2021 Accepting new patients
Missouri Baptist Hospital of Sullivan CurrentSince Sep 1, 2022 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

  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.