Active NPI
Pcrmc Medical Group, Inc
- Physical Medicine & Rehabilitation Physician
- Rolla, MO
National Provider Identifier
1508056540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- Legal business name
- PCRMC MEDICAL GROUP, INC
- Practice address
- 1050 W 10TH St
Rolla, MO 65401-2905 - Phone
- (573) 458-3431
- Fax
- (573) 458-3433
- NPI assigned
- Jul 26, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- John Denbo
- Title
- Ceo
- Phone
- (573) 458-8899
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | |||
| Physical Medicine & Rehabilitation Physician | 208100000X | Primary |
Addresses
Primary practice location
1050 W 10TH St
Rolla, MO 65401-2905
Mailing address
PO Box 579
Rolla, MO 65402-0579
Phone (314) 989-0300
Other names 1
- PCRMC Medical Group Rieth
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070829000437 | MO | Part B Supplier - Clinic/Group Practice | 1557454063 |
Receives reassigned benefits from 142 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Waynesville, MO; Vienna, MO; St James, MO; Salem, MO; Saint James, MO; Rolla, MO; Houston, MO |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185408000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1682899200000",
"number": "1508056540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 579",
"city": "ROLLA",
"state": "MO",
"postal_code": "654020579",
"telephone_number": "314-989-0300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 W 10TH ST",
"city": "ROLLA",
"state": "MO",
"postal_code": "654012905",
"telephone_number": "573-458-3431",
"fax_number": "573-458-3433"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PCRMC MEDICAL GROUP, INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-07-26",
"last_updated": "2023-05-01",
"certification_date": "2023-05-01",
"status": "A",
"authorized_official_last_name": "DENBO",
"authorized_official_first_name": "JOHN",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "573-458-8899"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "208100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Medicine & Rehabilitation",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "PCRMC Medical Group Rieth",
"code": "5",
"type": "Other Name"
},
{
"organization_name": "PCRMC Medical Group Rieth",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; 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.