NPIMap

Organization Active NPI

Mercy Clinic-Springfield Communities

Doing business as Mercy Clinic Family Medicine-Houston

  • Rural Health Clinic/Center
  • Houston, MO
National Provider Identifier
1487783296
Registry record updated Jun 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY CLINIC-SPRINGFIELD COMMUNITIES
Doing business as
Mercy Clinic Family Medicine-Houston
Practice address
1422 S Sam Houston Blvd
Houston, MO 65483
Phone
(417) 967-4445
Fax
(417) 967-4453
NPI assigned
Mar 5, 2007
Last updated
Jun 12, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2018

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

Authorized official

Name
Stuart G. Stangeland
Title
Senior Vice President/Coo
Phone
(417) 820-3873

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X MO Primary
Family Nurse Practitioner 363LF0000X 130675 MO
Family Nurse Practitioner 363LF0000X 119291 MO
Family Medicine Physician 207Q00000X 2005013261 MO

Addresses

Primary practice location

1422 S Sam Houston Blvd
Houston, MO 65483

Mailing address

645 Maryville Centre Dr FL 3
Saint Louis, MO 63141-5855
Phone (417) 820-7133

Other identifiers 1

IdentifierTypeStateIssuer
597932607MedicaidMO

Other names 1

  • Mercy Clinic Family Medicine-Houston Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031218000354 MO Part B Supplier - Clinic/Group Practice 7416865845 Receives reassigned benefits from 1,639 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 29

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 29

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528761600000",
    "number": "1487783296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 MARYVILLE CENTRE DR FL 3",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415855",
            "telephone_number": "417-820-7133",
            "fax_number": "417-820-0586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1422 S SAM HOUSTON BLVD",
            "city": "HOUSTON",
            "state": "MO",
            "postal_code": "65483",
            "telephone_number": "417-967-4445",
            "fax_number": "417-967-4453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY CLINIC-SPRINGFIELD COMMUNITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2018-06-12",
        "status": "A",
        "authorized_official_last_name": "STANGELAND",
        "authorized_official_first_name": "STUART",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT/COO",
        "authorized_official_telephone_number": "417-820-3873"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "130675",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "119291",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2005013261",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "597932607",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Clinic Family Medicine-Houston",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Clinic Family Medicine-Houston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Houston, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2018; 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.