Kirksville Academic Medicine LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

KIRKSVILLE ACADEMIC MEDICINE LLC

Practice address

800 W Jefferson St
Kirksville, MO 63501-1443

Phone

(660) 626-2235

Fax

(660) 626-2090

NPI assigned

Mar 8, 2007

Last updated

Oct 21, 2009By the provider in NPPES

Organization subpart

Yes

Parent organization

KIRKSVILLE ACADEMIC MEDICINE LLCAs reported in NPPES

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

Authorized official

Name

Debbie T Brewer

Title

Director of Provider Enrollment

Phone

(877) 892-9813

Specialties & licenses 5

Addresses

Other identifiers 3

Part of

Kirksville Academic Medicine LLC

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Scott A Anderson, D.O.

  • Hematology & Oncology Physician
  • Columbia, MO
  • NPI 1154302677
  NPD (past)
• Kathy Ayers, F.N.P.

  • Nurse Practitioner
  • Kirksville, MO
  • NPI 1083695829
  NPD (past)
• Robert Daniel Floyd, D.O.

  • Internal Medicine Physician
  • Bloomfield, IA
  • NPI 1275514028
  NPD (past)
• Kelly Michael Foley, PA-C

  • Physician Assistant
  • Clarksville, TN
  • NPI 1902025448
  NPD (past)
• Samuel Shin Kwon Lee, M.D.

  • Urology Physician
  • Apple Valley, CA
  • NPI 1194772418
  NPD (past)
• Donald R Noll, DO

  • Geriatric Medicine (Internal Medicine) Physician
  • Stratford, NJ
  • NPI 1093708067
  NPD (past)

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256083200000",
    "number": "1396876355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 W JEFFERSON ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635011443",
            "telephone_number": "660-626-2235",
            "fax_number": "660-626-2090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 W JEFFERSON ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635011443",
            "telephone_number": "660-626-2235",
            "fax_number": "660-626-2090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIRKSVILLE ACADEMIC MEDICINE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KIRKSVILLE ACADEMIC MEDICINE LLC",
        "enumeration_date": "2007-03-08",
        "last_updated": "2009-10-21",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "877-892-9813"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0765826",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "218276",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "504459702",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chris Kim
• Dana Kimmel, HIS
• Joanne Kincaid, RBT
• Kade Earl Kinney, DO
• Jacqueline Elise Kirkpatrick, FNP-BC
• Kirksville Allergy and Asthma, LLC
• Kirksville Anesthesia Associates, P.C.
• Kirksville Chiropractic and Rehabilitation LLC
• Kirksville Clinic Corp
• Kirksville Dental Group

• Internal Medicine Physician in Kirksville, MO
• Providers in Kirksville, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.