David Douglas, P.A.C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2004022171 Issued in MO

Practice address

755 Cowan Dr
Lebanon, MO 65536-4629

Phone

(417) 532-2805

Fax

(417) 532-2865

NPI assigned

Jul 12, 2006

Last updated

Nov 27, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advocates for a Healthy Community IncGroup PAC ID 5395653562, 55 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: david.douglas.p1@direct.jordanvalley.nextgenshare.com
• Direct secure messaging: ddouglas405815@directb.mercy.net
• Direct secure messaging: ddouglas694337@direct.ochin.org

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.

• Advocates for a Healthy Community, Inc

  dba Jordan Valley Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Springfield, MO
  • NPI 1558303057
  Medicare reassignment Care Compare group NPD
• Lake Regional Health System

  • Emergency Medical Services (Emergency Medicine) Physician
  • Osage Beach, MO
  • NPI 1053581454
  Medicare reassignment NPD
• Mercy Clinic Springfield Communities

  • Family Medicine Physician
  • Springfield, MO
  • NPI 1245277631
  Medicare reassignment NPD
• Mercy Clinic Springfield Communities

  dba Mercy Clinic Family Medicine-Willow Springs

  • Rural Health Clinic/Center
  • Willow Springs, MO
  • NPI 1972771657
  Medicare reassignment NPD
• Mercy Southern Missouri Ambulatory Services LLC

  • Urgent Care Clinic/Center
  • Springfield, MO
  • NPI 1871094052
  Medicare reassignment
• Advocates for a Healthy Community Inc

  dba Jordan Valley Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Buffalo, MO
  • NPI 1750179610
  NPD
• Lake Regional Health System

  dba Lake Regional Orthopedics

  • Durable Medical Equipment & Medical Supplies
  • Lebanon, MO
  • NPI 1578125324
  NPD
• Mercy Clinic Springfield Communities

  dba Mercy Clinic Family Medicine-Richland

  • Rural Health Clinic/Center
  • Richland, MO
  • NPI 1972635639
  NPD
• Advocates for a Healthy Community, Inc.

  dba Jordan Valley Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Springfield, MO
  • NPI 1861590861
  NPD (past)
• Hartville Medical Center Inc

  • Rural Health Clinic/Center
  • Hartville, MO
  • NPI 1518902352
  NPD (past)
• Hartville Medical Center Inc

  • General Practice Physician
  • Hartville, MO
  • NPI 1609949403
  NPD (past)
• Mercy Clinic Springfield Communities

  • Psychologist
  • Springfield, MO
  • NPI 1881636884
  NPD (past)

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1396760476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 517",
            "city": "MARSHFIELD",
            "state": "MO",
            "postal_code": "657060517",
            "telephone_number": "417-849-5072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 COWAN DR",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655364629",
            "telephone_number": "417-532-2805",
            "fax_number": "417-532-2865"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "904 S Pine St",
            "address_purpose": "LOCATION",
            "city": "Richland",
            "state": "MO",
            "postal_code": "655567393",
            "country_code": "US",
            "telephone_number": "573-765-2956",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "P.A.C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2004022171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC, HARTVILLE MEDICAL CEN",
            "identifier": "202941",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC, VALLEY MEDICAL CENTER",
            "identifier": "202943",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220024481",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aaron Dent, D.O.
• Dental Professionals of Missouri, Richard Straus, D.M.D., P.C. (Forum Dental - Lebanon)
• Matthew R Derr, LPC
• Robert C Desko, M.D.
• Raegan D Dettlaff, LPC
• Anna Marie Dryer, NP
• Amy Patricia Dunckel, PT
• Micheal J Durham, D.O.
• Rebecca Eadie, LMT
• Megean A. Eggert, PLMFT

• Physician Assistant in Lebanon, MO
• Providers in Lebanon, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.

Verify at the official NPI Registry.