Active NPI
Jerry W Dorris, FNP-C
- Family Nurse Practitioner
- Buffalo, MO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 148324
- Practice address
- 118 W Dallas St
Buffalo, MO 65622-8669 - Phone
- (417) 345-6101
- Fax
- (417) 829-4316
- NPI assigned
- Sep 24, 2006
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 148324 | MO | Primary |
Addresses
Primary practice location
118 W Dallas St
Buffalo, MO 65622-8669
Mailing address
118 W Dallas St
Buffalo, MO 65622-8669
Phone (417) 345-6101
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 421151309 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070501000134 | MO | Practitioner - Nurse Practitioner | 0345346805 | Reassigns benefits to 2 organizations |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 148324 | MO | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Clinic Springfield Communities | Current | Accepting new patients | |
| Mercy Clinic Springfield Communities | Current | Accepting new patients | |
| Mercy Clinic Springfield Communities | Family | Current | Accepting new patients |
| Lincoln County Hospital | Past | Accepting new patients |
Locations
118 W Dallas St
Buffalo, MO 65622
Phone (417) 345-6101
1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379
1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379
2120 W Kearney St
Springfield, MO 65803
Phone (417) 831-8074
2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905
1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115
363 E Old Route 66
Strafford, MO 65757
Phone (417) 736-9175
Interoperability endpoints
- jdorris22408@directc.mercy.net
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Rural Health Clinic/Center
- Willow Springs, MO
- NPI 1972771657
Family, MO
-
- Family Medicine Physician
- Hollister, MO
- NPI 1053350454
-
- Critical Access Hospital
- Lincoln, KS
- NPI 1942265327
Hospital & facility affiliations 11
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mercy Clinic Springfield Communities
Practice addresses (Care Compare)
118 W Dallas St
MC Family Medicine Buffalo
Buffalo, MO 65622-8669
Phone (417) 345-6101
2120 W Kearney St
MC Occupational Medicine W Kearney
Springfield, MO 65803-1653
Phone (417) 869-6191
Hospital & facility affiliations
- Mercy Hospital Springfield
- Mercy Hospital Lebanon
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635292800000",
"number": "1386744811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 W DALLAS ST",
"city": "BUFFALO",
"state": "MO",
"postal_code": "656228669",
"telephone_number": "417-345-6101",
"fax_number": "417-829-4316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 W DALLAS ST",
"city": "BUFFALO",
"state": "MO",
"postal_code": "656228669",
"telephone_number": "417-345-6101",
"fax_number": "417-829-4316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DORRIS",
"first_name": "JERRY",
"middle_name": "W",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-24",
"last_updated": "2021-10-27",
"certification_date": "2021-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MO",
"license": "148324",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "421151309",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2021; 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.