Myrna Ivelisse Gover Havener, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2010036458 Issued in MO

Practice address

1780 Old Highway 50 E
Union, MO 63084

Phone

(888) 403-1071

NPI assigned

Aug 8, 2006

Last updated

Apr 12, 2024By 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

Other identifiers 2

Other names 1

• Dr. Myrna Ivelisse Gover Lepich Former name

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sound Physicians of Illinois, LLC

  • Hospitalist Physician
  • Bridgeton, MO
  • NPI 1043598865

  Internal Medicine

  Medicare reassignment NPD
• Jefferson Physician Network, LLC

  • Vascular Surgery Physician
  • Festus, MO
  • NPI 1558508606
  NPD (past)
• Midwest Doctors Group, LLC

  dba Mid-America Sports Medicine and Wellness

  • Sports Medicine (Family Medicine) Physician
  • Independence, MO
  • NPI 1841462314
  NPD (past)

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1487664942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 MASON RIDGE CENTER DR STE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418512",
            "telephone_number": "314-448-3791",
            "fax_number": "314-996-7658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1780 OLD HIGHWAY 50 E",
            "city": "UNION",
            "state": "MO",
            "postal_code": "63084",
            "telephone_number": "888-403-1071"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "249 Twin Lakes Dr",
            "address_purpose": "LOCATION",
            "city": "Union",
            "state": "MO",
            "postal_code": "630842865",
            "country_code": "US",
            "telephone_number": "573-578-6865",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1110 Highlands Plaza Dr E Ste 220",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101351",
            "country_code": "US",
            "telephone_number": "636-240-5454",
            "fax_number": "636-980-5335",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOVER HAVENER",
        "first_name": "MYRNA",
        "middle_name": "IVELISSE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-08",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2010036458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145265801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI STATE BOARD OF REGISTRATION",
            "identifier": "2010036458",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1110 Highlands Plaza Dr E Ste 220",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MYRNA",
            "last_name": "GOVER LEPICH",
            "middle_name": "IVELISSE",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Holle E. Gilbert, PTA
• Janise Gildehaus
• Christi D Gills, LPC
• Jenifer K Goers, MA, PLPC
• Megan Elizabeth Goss, D.C.
• Grace's Place, Inc.
• Courtney Michelle Granger, PLPC
• Emily Aurelia Gray, LCSW
• Robert L Guth, SPEECH & LANGUAGE SP
• Darleen Ann Hainline, BCBA

• Internal Medicine Physician in Union, MO
• Providers in Union, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.