Active NPI
Occupational Medicine of Mid Missouri II
- Occupational Medicine Physician
- Columbia, MO
National Provider Identifier
1508454125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Medicine Physician
- Legal business name
- OCCUPATIONAL MEDICINE OF MID MISSOURI II
- Practice address
- 401 N Keene St
Columbia, MO 65201-6625 - Phone
- (573) 876-1600
- NPI assigned
- Jan 8, 2021
- 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
- Shirley Duff
- Title
- Practice Manager
- Phone
- (573) 876-1600
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Medicine Physician | 2083X0100X | Primary |
Addresses
Primary practice location
401 N Keene St
Columbia, MO 65201-6625
Mailing address
401 N Keene St
Columbia, MO 65201-6625
Phone (573) 876-1600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210115001356 | MO | Part B Supplier - Mass Immunization (Roster Biller Only) | 9931512795 | Practice locations: Columbia, MO |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0992249 | Occupational Medicine of Mid Missouri | Certificate of waiver | Oct 10, 2027 |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610064000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1610064000000",
"number": "1508454125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 N KEENE ST",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652016625",
"telephone_number": "573-876-1600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 N KEENE ST",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652016625",
"telephone_number": "573-876-1600"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OCCUPATIONAL MEDICINE OF MID MISSOURI II",
"organizational_subpart": "NO",
"enumeration_date": "2021-01-08",
"last_updated": "2021-01-08",
"certification_date": "2021-01-08",
"status": "A",
"authorized_official_last_name": "DUFF",
"authorized_official_first_name": "SHIRLEY",
"authorized_official_title_or_position": "PRACTICE MANAGER",
"authorized_official_telephone_number": "573-876-1600"
},
"taxonomies": [
{
"code": "2083X0100X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Preventive Medicine, Occupational Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2021; 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.