NPIMap

Organization Active NPI

McPherson Medical & Diagnostic, LLC

  • Family Medicine Physician
  • Gideon, MO
National Provider Identifier
1497189864
Registry record updated Oct 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R9E31 Issued in MO
Legal business name
MCPHERSON MEDICAL & DIAGNOSTIC, LLC
Practice address
100 N Main St
Gideon, MO 63848-9253
Phone
(573) 448-3800
NPI assigned
Aug 21, 2013
Last updated
Oct 3, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
MCPHERSON MEDICAL & DIAGNOSTIC, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 3, 2019

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

Authorized official

Name
Paula J Anderson
Title
Office Administrator
Phone
(573) 695-2181

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R9E31 MO Primary

Addresses

Primary practice location

100 N Main St
Gideon, MO 63848-9253

Mailing address

PO Box 12545
Belfast, ME 04915-4016
Phone (573) 448-3800

Other names 1

  • Gideon Medical Center-MMD Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061201000167 MO Part B Supplier - Clinic/Group Practice 5698773539 Receives reassigned benefits from 116 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kennett, MO; Macon, MO; Malden, MO; Saint Louis, MO; Saint Peters, MO; Scott City, MO; Steele, MO; Moberly, MO…

Other NPIs on the same Medicare enrollment 23

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

View all 23

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0717447Gideon Medical Center100 South Main, Gideon, MO 63848Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
McPherson Medical Diagnost37 organizations share this tax ID, including this one
Part of
McPherson Medical Diagnost

Other organizations with this tax ID 36

Organizations that report the same tax identification number in the National Provider Directory.

View all 36

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1377043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570060800000",
    "number": "1497189864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12545",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154016",
            "telephone_number": "573-448-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N MAIN ST",
            "city": "GIDEON",
            "state": "MO",
            "postal_code": "638489253",
            "telephone_number": "573-448-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCPHERSON MEDICAL & DIAGNOSTIC, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCPHERSON MEDICAL & DIAGNOSTIC, LLC",
        "enumeration_date": "2013-08-21",
        "last_updated": "2019-10-03",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "573-695-2181"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R9E31",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gideon Medical Center-MMD",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Gideon Medical Center-MMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gideon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.