Active NPI
Michael Daly
- Family Medicine Physician
- Columbia, MO
National Provider Identifier
1447361100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 33542
- Practice address
- 1605 E Broadway
Suite 110
Columbia, MO 65201-8023 - Phone
- (573) 815-2236
- Fax
- (573) 815-2232
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 33542 | MO | Primary |
Addresses
Primary practice location
1605 E Broadway
Suite 110
Columbia, MO 65201-8023
Mailing address
670 Mason Ridge Center Dr
Ste 300
Saint Louis, MO 63141-8573
Phone (573) 815-2236
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 240220228 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R7880 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physician Groups LC | Family Medicine | Past | Accepting new patients |
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": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380585600000",
"number": "1447361100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "670 MASON RIDGE CENTER DR",
"address_2": "STE 300",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418573",
"telephone_number": "573-815-2236",
"fax_number": "573-815-2232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1605 E BROADWAY",
"address_2": "SUITE 110",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652018023",
"telephone_number": "573-815-2236",
"fax_number": "573-815-2232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DALY",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2013-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "33542",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "240220228",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.