NPIMap

Individual provider Active NPI

Dustin Charles Carpenter, M.D.

  • Family Medicine Physician
  • Mound City, MO
National Provider Identifier
1396033072
Registry record updated Jul 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
6444 Issued in NE
Practice address
514 State St
Mound City, MO 64470-1145
Phone
(660) 686-2329
Fax
(660) 686-2799
NPI assigned
Jul 15, 2011
Last updated
Jul 22, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 22, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 6444 NE Primary

Addresses

Primary practice location

514 State St
Mound City, MO 64470-1145

Mailing address

909 N 6TH St
Tarkio, MO 64491-1119
Phone (816) 309-8028

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141013001484 MO Practitioner - Family Practice 0749400893 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Hospital AssociationGroup PAC ID 1557316783, 8 clinicians

Practice addresses (Care Compare)

26136 US Hwy 59
Fairfax, MO 64446-9105
Phone (660) 686-2276

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6444NEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Hospital Association Family Medicine CurrentSince Sep 2, 2014 Accepting new patients
Community Hospital Association CurrentSince Sep 2, 2014 Accepting new patients
Community Hospital Association CurrentSince Dec 8, 2025 Accepting new patients
Tiffany Healthcare LLC Past Accepting new patients

Locations

26136 US Highway 59
Fairfax, MO 64446
Phone (660) 686-2211

514 State St
Mound City, MO 64470
Phone (660) 442-3181

514 State St
#C
Mound City, MO 64470

100 E Cass St
Rock Port, MO 64482
Phone (660) 744-5361

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mound City Family MedicineMound City, MO, CCN 268755 Rural health clinic Corporate Director Jul 21, 2014
Tarkio Family MedicineTarkio, MO, CCN 268771 Rural health clinic Corporate Director Jul 21, 2014

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1310688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405987200000",
    "number": "1396033072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 N 6TH ST",
            "city": "TARKIO",
            "state": "MO",
            "postal_code": "644911119",
            "telephone_number": "816-309-8028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 STATE ST",
            "city": "MOUND CITY",
            "state": "MO",
            "postal_code": "644701145",
            "telephone_number": "660-686-2329",
            "fax_number": "660-686-2799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARPENTER",
        "first_name": "DUSTIN",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-15",
        "last_updated": "2014-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "6444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mound City, MO

Sources for this page

Verify at the official NPI Registry.