NPIMap

Individual provider Active NPI

Paul Berry Andelin, M.D.

  • Family Medicine Physician
  • Aurora, MO
National Provider Identifier
1457413858
Registry record updated Jan 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MDR3M76 Issued in MO
Practice address
203 S Washington Ave Ste a
Aurora, MO 65605-1466
Phone
(417) 678-4022
Fax
(417) 678-4028
NPI assigned
Dec 14, 2006
Last updated
Jan 31, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 31, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MDR3M76 MO Primary

Addresses

Primary practice location

203 S Washington Ave Ste a
Aurora, MO 65605-1466

Mailing address

1937 W Cardinal LN
Aurora, MO 65605-1977
Phone (417) 678-6328

Other practice location 1

2195 N Citation Ave
Springfield, MO 65802-5420
Phone (417) 476-3033

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
I20050223000923 MO Practitioner - Family Practice 1254384894 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Saint Louis University School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Hospital AuroraGroup PAC ID 9436063211, 7 clinicians
Mercy Hospital CassvilleGroup PAC ID 8820999139, 10 clinicians

Practice addresses (Care Compare)

500 Porter Ave
Aurora, MO 65605-2365
Phone (417) 678-2122

94 Main St
Cassville, MO 65625-1610
Phone (417) 847-6000

94 S Main St
Cassville, MO 65625-1610

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MDR3M76MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Cassville CurrentSince Jan 1, 2007 Accepting new patients
Mercy Hospital Cassville CurrentSince Jan 1, 2007 Accepting new patients
Hometown Medical Group, LLC Family Medicine CurrentSince Mar 29, 2022 Accepting new patients
Mercy Hospital Aurora CurrentSince Jul 1, 2002 Accepting new patients
Mercy Hospital Aurora CurrentSince Jul 1, 2002 Accepting new patients
Medical Partners of Aurora, LLC Family Medicine Past Accepting new patients

Locations

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

94 Main St
Cassville, MO 65625
Phone (417) 782-7722

101 N Elm St
Ste D
Pierce City, MO 65723
Phone (417) 297-0515

Organizations & group practices 7

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 12

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

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1457413858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1937 W CARDINAL LN",
            "city": "AURORA",
            "state": "MO",
            "postal_code": "656051977",
            "telephone_number": "417-678-6328",
            "fax_number": "417-678-4028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 S WASHINGTON AVE STE A",
            "city": "AURORA",
            "state": "MO",
            "postal_code": "656051466",
            "telephone_number": "417-678-4022",
            "fax_number": "417-678-4028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2195 N Citation Ave",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658025420",
            "country_code": "US",
            "telephone_number": "417-476-3033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDELIN",
        "first_name": "PAUL",
        "middle_name": "BERRY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "MDR3M76",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, MO

Sources for this page

Verify at the official NPI Registry.