NPIMap

Organization Active NPI

Bhgxxix, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Poplar Bluff, MO
National Provider Identifier
1508277229
Registry record updated Dec 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
BHGXXIX, LLC
Practice address
1369 N Westwood Blvd
Poplar Bluff, MO 63901-3313
Phone
(573) 772-7937
Fax
(573) 778-1315
NPI assigned
May 15, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2019

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

Authorized official

Name
Jemece Michelle Gasaway
Title
Director of Licensing
Phone
(214) 365-6126

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Methadone Clinic 261QM2800X MO
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

1369 N Westwood Blvd
Poplar Bluff, MO 63901-3313

Mailing address

5001 Spring Valley Road
Suite 600 East
Dallas, TX 75244-5603
Phone (214) 365-6100

Other names 1

  • BHG Poplar Bluff Treatment Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151014001334 MO Part B Supplier - Clinic/Group Practice 0648589671 Receives reassigned benefits from 10 practitioners
Practice locations: Poplar Bluff, MO
O20191221000391 MO Part B Supplier - Opioid Treatment Program (Otp) 0648589671 Practice locations: Poplar Bluff, MO

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
26D2078309BHG Xxix, LLC D/B/a BHG Poplar Bluff Treatment1369 North Westwood Boulevard, Suite C, Poplar Bluff, MO 63901Certificate of waiverMay 26, 2028

National Provider Directory

National Provider Directory

Locations

8300 Douglas Ave
Ste 750
Dallas, TX 75225

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1400112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576540800000",
    "number": "1508277229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5001 SPRING VALLEY ROAD",
            "address_2": "SUITE 600 EAST",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752445603",
            "telephone_number": "214-365-6100",
            "fax_number": "214-365-6150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1369 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013313",
            "telephone_number": "573-772-7937",
            "fax_number": "573-778-1315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BHGXXIX, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-15",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A",
        "authorized_official_last_name": "GASAWAY",
        "authorized_official_first_name": "JEMECE",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "DIRECTOR OF LICENSING",
        "authorized_official_telephone_number": "214-365-6126"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BHG Poplar Bluff Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BHG Poplar Bluff Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.