Jefferson Medical Group

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

JEFFERSON MEDICAL GROUP

Practice address

105 E 2ND St
Norborne, MO 64668-1301

Phone

(660) 593-3623

Fax

(660) 593-3628

NPI assigned

Apr 12, 2011

Last updated

Oct 29, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amy Danielle Ireland

Title

Cfo

Phone

(660) 329-6005

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jefferson Medical Group Norborne Clinic Other name

Electronic endpoints 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Carroll County Memorial Hospital

  • Critical Access Hospital
  • Carrollton, MO
  • NPI 1528067113

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1302566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635465600000",
    "number": "1467742452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 N JEFFERSON ST",
            "city": "CARROLLTON",
            "state": "MO",
            "postal_code": "646331948",
            "telephone_number": "660-542-9998",
            "fax_number": "660-542-9880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E 2ND ST",
            "city": "NORBORNE",
            "state": "MO",
            "postal_code": "646681301",
            "telephone_number": "660-593-3623",
            "fax_number": "660-593-3628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-12",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A",
        "authorized_official_last_name": "IRELAND",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "DANIELLE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "660-329-6005"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "596573204",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "CCMHHIMDept@ccmhospital.cernerdirect.com",
            "affiliation": "Y",
            "affiliationName": "Carroll County Memorial Hospital",
            "address_1": "1502 N Jefferson St",
            "city": "Carrollton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "646331948",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Jefferson Medical Group Norborne Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Jefferson Medical Group Norborne Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• County of Carroll School Dist R8
• Maryanne Catherine Crone-Markley, LCSW, ACSW, MS.
• Stacy Lynn Davidson, RN
• Elizabeth A Heil, PHARMD
• Suzanne L. Kruse
• New Choices Counseling LLC

• Rural Health Clinic/Center in Norborne, MO
• Providers in Norborne, MO by specialty
• Rural Health Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.