Elyssa Ann Gibbons, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2017026630 Issued in MO

Practice address

1731 Daniel Boone LN
Boonville, MO 65233-2864

Phone

(660) 537-3908

NPI assigned

Jul 27, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Elyssa Eichelberger Former name

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Boone Physician Services LLCGroup PAC ID 6507090644, 243 clinicians

Central Missouri Physical Therapy LLCGroup PAC ID 6901870187, 59 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Boone Physician Services, LLC

  • Multi-Specialty Clinic/Center
  • Columbia, MO
  • NPI 1760893259

  MO

  Medicare reassignment Care Compare group NPD
• Central Missouri Physical Therapy LLC

  • Physical Therapist
  • Columbia, MO
  • NPI 1558436592

  MO, Physical Therapist

  Medicare reassignment Care Compare group NPD
• Boone Physician Services LLC

  • Rural Health Clinic/Center
  • Mexico, MO
  • NPI 1376380659
  Care Compare group
• Boone Physician Services LLC

  • Rural Health Clinic/Center
  • Moberly, MO
  • NPI 1538906813
  Care Compare group
• Boone Physician Services LLC

  • Rural Health Clinic/Center
  • Boonville, MO
  • NPI 1558108837
  Care Compare group
• Boone Physician Services, LLC

  • Rural Health Clinic/Center
  • Centralia, MO
  • NPI 1619648532
  Care Compare group
• Bothwell Regional Health Center

  • Rural Health Clinic/Center
  • Cole Camp, MO
  • NPI 1497705313
  NPD (past)

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

{
    "created_epoch": "1627344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1447923313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1731 DANIEL BOONE LN",
            "city": "BOONVILLE",
            "state": "MO",
            "postal_code": "652332864",
            "telephone_number": "660-537-3908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1731 DANIEL BOONE LN",
            "city": "BOONVILLE",
            "state": "MO",
            "postal_code": "652332864",
            "telephone_number": "660-537-3908"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3301 Berrywood Dr Ste 204",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652016517",
            "country_code": "US",
            "telephone_number": "573-449-8771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBBONS",
        "first_name": "ELYSSA",
        "middle_name": "ANN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-27",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2017026630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELYSSA",
            "last_name": "EICHELBERGER",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• John Douglas Foster II, RN
• Lyndi Geha
• Sammy H Goedrich, OTR
• Tanner Wayne Green, DC, ATC
• Yvonne Guest, DPT
• Jennifer Jo Hackman, P.T. ,A.T.C.
• Laura S Haines, MA, LPC

• All providers in Boonville, MO
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; 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.