Jerri Dawn Robertson, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2006018426 Issued in MO

Practice address

3460 S Clark St
Mexico, MO 65265-4124

Phone

(573) 581-9630

NPI assigned

Apr 13, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Capital Region Medical Center

  dba Capital Region Medical Clinic-Stover

  • Family Medicine Physician
  • Stover, MO
  • NPI 1215906433
  NPD (past)

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1407070816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3460 S CLARK ST",
            "city": "MEXICO",
            "state": "MO",
            "postal_code": "652654124",
            "telephone_number": "573-581-9630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3460 S CLARK ST",
            "city": "MEXICO",
            "state": "MO",
            "postal_code": "652654124",
            "telephone_number": "573-581-9630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "JERRI",
        "middle_name": "DAWN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-13",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "MO",
            "license": "2006018426",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2006018426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alicia Marie Reichert, LPC
• Kim Joseph Rettenmaier, MD
• Marvin Elliott Rice, DDS
• Marvin Elwood Rice, DDS
• Brianne Rivers, PHARM. D.
• Katherine D Robinson, MS
• Sarah M Roling, DC
• McKenzi Kea Ross, FNP
• Justine Nikole Rush
• Tyler Lee Sanders, PA-C

• Family Medicine Physician in Mexico, MO
• Providers in Mexico, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.