NPIMap

Organization Active NPI

Midwest OB GYN of Missouri, LLC

  • Rural Health Clinic/Center
  • Poplar Bluff, MO
National Provider Identifier
1396337473
Registry record updated Mar 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MIDWEST OB GYN OF MISSOURI, LLC
Practice address
2210 Barron Rd Ste 206
Poplar Bluff, MO 63901-1908
Phone
(573) 772-7000
NPI assigned
Feb 9, 2021
Organization subpart
Yes
Parent organization
MIDWEST OB GYN OF MISSOURI, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 5, 2021

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

Authorized official

Name
John R Patty, DONPI 1326094566
Title
Owner/Physician
Phone
(573) 772-7000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

2210 Barron Rd Ste 206
Poplar Bluff, MO 63901-1908

Mailing address

PO Box 1007
Poplar Bluff, MO 63902-1007
Phone (573) 772-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210430000555 MO Part A Provider - Rural Health Clinic 3870853294 Practice locations: Poplar Bluff, MO

Rural health clinic certification: CCN 793857

Legal name
MIDWEST OB GYN OF MISSOURI LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 24, 2022
Last certification
Mar 24, 2025
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Sep 14, 2016 in MO
Enrollment address
2210 Barron Rd
Ste 206
Poplar Bluff, MO 63901-1908

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Midwest OB GYN of Missouri LLC2 organizations share this tax ID, including this one
Part of
Midwest OB GYN of Missouri LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Sindy Smith Individual W-2 Managing Employee Apr 1, 2021
John R Patty Individual 5% Or Greater Direct Ownership Interest Apr 1, 2021 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1612828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614902400000",
    "number": "1396337473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1007",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639021007",
            "telephone_number": "573-772-7000",
            "fax_number": "573-686-1315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2210 BARRON RD STE 206",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639011908",
            "telephone_number": "573-772-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST OB GYN OF MISSOURI, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIDWEST OB GYN OF MISSOURI, LLC",
        "enumeration_date": "2021-02-09",
        "last_updated": "2021-03-05",
        "certification_date": "2021-03-05",
        "status": "A",
        "authorized_official_last_name": "PATTY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "573-772-7000",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poplar Bluff, MO

Sources for this page

Verify at the official NPI Registry.