Active NPI
Michael W Mahoney, DO
- Family Medicine Physician
- Hermann, MO
National Provider Identifier
1497890867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R6775
- Practice address
- 134 W 6TH St
Hermann, MO 65041-1018 - Phone
- (573) 486-5711
- Fax
- (573) 486-3827
- NPI assigned
- Feb 21, 2007
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R6775 | MO | Primary |
Addresses
Primary practice location
134 W 6TH St
Hermann, MO 65041-1018
Mailing address
PO Box 19
Hermann, MO 65041-0019
Phone (573) 486-1193
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 240883801 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1497890867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19",
"city": "HERMANN",
"state": "MO",
"postal_code": "650410019",
"telephone_number": "573-486-1193",
"fax_number": "573-486-0910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "134 W 6TH ST",
"city": "HERMANN",
"state": "MO",
"postal_code": "650411018",
"telephone_number": "573-486-5711",
"fax_number": "573-486-3827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHONEY",
"first_name": "MICHAEL",
"middle_name": "W",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-21",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "R6775",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "240883801",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hermann, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.