NPIMap

Organization Active NPI

Van Ness Orthopedics & Sports Medicine Inc

  • Orthopaedic Surgery Physician
  • Farmington, MO
National Provider Identifier
1477579860
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
DO116378 Issued in MO
Legal business name
VAN NESS ORTHOPEDICS & SPORTS MEDICINE INC
Practice address
606 Maple Valley Dr
Farmington, MO 63640-1976
Phone
(573) 756-7779
Fax
(573) 756-6914
NPI assigned
Jul 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2024

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

Authorized official

Name
Amy Ford
Title
Office Manager
Phone
(573) 756-7779

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X DO116378 MO Primary

Addresses

Primary practice location

606 Maple Valley Dr
Farmington, MO 63640-1976

Mailing address

606 Maple Valley Dr
Farmington, MO 63640-1976
Phone (573) 756-7779

Other identifiers 2

IdentifierTypeStateIssuer
506060300MedicaidMO
200036577OtherMOMEDICARE RR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040927001017 MO Part B Supplier - Clinic/Group Practice 6406825405 Receives reassigned benefits from 4 practitioners
Practice locations: Farmington, MO
O20100930016033 MO DME Supplier - Physician - Orthopedic/Orthopedic Surgery 6406825405 Practice locations: Farmington, MO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716336000000",
    "number": "1477579860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 MAPLE VALLEY DR",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636401976",
            "telephone_number": "573-756-7779",
            "fax_number": "573-756-6914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 MAPLE VALLEY DR",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636401976",
            "telephone_number": "573-756-7779",
            "fax_number": "573-756-6914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN NESS ORTHOPEDICS & SPORTS MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "573-756-7779"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "MO",
            "license": "DO116378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "506060300",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "200036577",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.