Putnam County Medical Home Clinics, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PUTNAM COUNTY MEDICAL HOME CLINICS, LLC

Practice address

103 S 18TH St
Unionville, MO 63565-1642

Phone

(660) 947-2300

Fax

(660) 947-2307

NPI assigned

Oct 24, 2016

Organization subpart

No

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

Authorized official

Name

Dawn FairleyNPI 1801832373

Title

Sole Owner

Phone

(610) 737-4704

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14935/brand/1/csg/1/fhir/r4

Practitioners 1

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

• Dawn A Fairley, DO

  • Family Medicine Physician
  • Unionville, MO
  • NPI 1801832373
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1477267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477267200000",
    "number": "1437600657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 GREEN ST",
            "city": "UNIONVILLE",
            "state": "MO",
            "postal_code": "635651426",
            "telephone_number": "610-737-4704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 S 18TH ST",
            "city": "UNIONVILLE",
            "state": "MO",
            "postal_code": "635651642",
            "telephone_number": "660-947-2300",
            "fax_number": "660-947-2307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUTNAM COUNTY MEDICAL HOME CLINICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-24",
        "last_updated": "2016-10-24",
        "status": "A",
        "authorized_official_last_name": "FAIRLEY",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "610-737-4704"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207348905",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "749127",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patient Care and Footware LLC
• Jill Payne
• Joel W. Pratt, D.D.S.
• Putnam County Ambulance District
• Putnam County Health Department
• Putnam County Memorial Hospital
• Putnam County Memorial Hospital
• Putnam County Memorial Hospital
• Putnam County Memorial Hospital
• Putnam County Memorial Hospital

• Family Medicine Physician in Unionville, MO
• Providers in Unionville, 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 24, 2016; 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.