Mary K Pendergrass, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2014030982 Issued in MO

Practice address

181 N Kentucky Ave Ste 100
West Plains, MO 65775-2092

Phone

(417) 257-5911

NPI assigned

Jul 11, 2012

Last updated

Jul 21, 2022By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Douglas County Public Health Services Group, Inc.Group PAC ID 3072423052, 25 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Interoperability endpoints

• Direct secure messaging: marypendergrass@omcmo.allscriptsdirect.net

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.

• Douglas County Public Health Services Group, Inc.

  dba Missouri Ozarks Community Health

  • Federally Qualified Health Center (FQHC)
  • Mansfield, MO
  • NPI 1912904004
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1341964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1457616872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "181 N KENTUCKY AVE STE 100",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657752092",
            "telephone_number": "417-257-5911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 N KENTUCKY AVE STE 100",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657752092",
            "telephone_number": "417-257-5911"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "816 E Main St",
            "address_purpose": "LOCATION",
            "city": "Willow Springs",
            "state": "MO",
            "postal_code": "657931518",
            "country_code": "US",
            "telephone_number": "417-269-2490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENDERGRASS",
        "first_name": "MARY",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-11",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2014030982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peace Valley Perinatal LLC (Peace Valley Perinatal)
• Catherine Renesa Pearson, FNP-BC
• Patrick Lynn Peck
• Brandy Peek
• Kendell Pellham
• Jan Peoples
• Rebecca Perez
• Perfect Partners, LLC
• Marcie Jo Perkins
• Stacey Lynn Perkins, MAADC II

• Family Medicine Physician in West Plains, MO
• Providers in West Plains, 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 Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.