NPIMap

Individual provider Active NPI

Ethan Thomas Hoerschgen, M.D.

  • Nephrology Physician
  • Springfield, MO
National Provider Identifier
1447332945
Registry record updated Feb 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
2007018015 Issued in MO
Practice address
1911 S National Ave
Suite 301
Springfield, MO 65804-2213
Phone
(417) 886-5000
Fax
(417) 886-1100
NPI assigned
Oct 20, 2006
Last updated
Feb 10, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2004014110 MO
Nephrology Physician 207RN0300X 2007018015 MO Primary

Addresses

Primary practice location

1911 S National Ave
Suite 301
Springfield, MO 65804-2213

Mailing address

1911 S National Ave
Suite 301
Springfield, MO 65804-2213
Phone (417) 886-5000

Other identifiers 1

IdentifierTypeStateIssuer
1447332945MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101206000618 MO Practitioner - NephrologyPractitioner - Internal Medicine 0547457327 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Saint Louis University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Springfield Nephrology Associates IncGroup PAC ID 6901905553, 13 clinicians

Practice addresses (Care Compare)

1911 S National Ave
Suite 301
Springfield, MO 65804-2213
Phone (417) 886-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2004014110MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Springfield Nephrology Associates Inc Nephrology CurrentSince Jan 2, 2011 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

500 Porter Ave
Aurora, MO 65605
Phone (417) 678-2122

120 Hospital Dr
Ste 250
Lebanon, MO 65536
Phone (417) 533-6710

1200 N Main St
Ste B
Mountain Grove, MO 65711

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

1911 S National Ave
Springfield, MO 65804

1911 S National Ave
Ste 301
Springfield, MO 65804
Phone (417) 725-8250

803 W Broadway St
West Plains, MO 65775
Phone (417) 255-1413

Interoperability endpoints

  • Direct secure messaging: ehoerschgen12054@direct.acumenmd.com

Organizations & group practices 2

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.

Hospital & facility affiliations 20

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297296000000",
    "number": "1447332945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1911 S NATIONAL AVE",
            "address_2": "SUITE 301",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042213",
            "telephone_number": "417-886-5000",
            "fax_number": "417-886-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 S NATIONAL AVE",
            "address_2": "SUITE 301",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042213",
            "telephone_number": "417-886-5000",
            "fax_number": "417-886-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOERSCHGEN",
        "first_name": "ETHAN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2011-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2004014110",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MO",
            "license": "2007018015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447332945",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.