Individual provider Active NPI

Randy Thomas Zimmerman, DC

  • Chiropractor
  • Saint Joseph, MO
National Provider Identifier
1407886245
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
006605 Issued in MO
Practice address
1307 B Village Drive
Saint Joseph, MO 64506-2457
Phone
(816) 390-9900
Fax
(816) 232-4357
NPI assigned
Jul 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 006605 MO Primary

Addresses

Primary practice location

1307 B Village Drive
Saint Joseph, MO 64506-2457

Mailing address

1307 B Village Drive
Saint Joseph, MO 64506-2457
Phone (816) 390-9900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101007001155 MO Practitioner - Chiropractic 0244422368 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3901 Beck Rd
Suite B
Saint Joseph, MO 64506-4923
Phone (816) 390-9900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
006605MOMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Zimmerman Chiropractic Inc. Chiropractor CurrentSince Oct 4, 2010 Accepting new patients

Locations

1307 Village Dr
Ste B
Saint Joseph, MO 64506
Phone (816) 390-9900

3901 Beck Rd
Ste B
Saint Joseph, MO 64506
Phone (816) 390-9900

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407886245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307 B VILLAGE DRIVE",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645062457",
            "telephone_number": "816-390-9900",
            "fax_number": "816-232-4357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 B VILLAGE DRIVE",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645062457",
            "telephone_number": "816-390-9900",
            "fax_number": "816-232-4357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIMMERMAN",
        "first_name": "RANDY",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "006605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.