Organization Active NPI

Occupational Medicine of Mid Missouri II

  • Occupational Medicine Physician
  • Columbia, MO
National Provider Identifier
1508454125
Registry record updated Jan 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine PhysicianTaxonomy code 2083X0100X
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

Updated by the provider on Jan 8, 2021

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)CodeLicenseStatePrimary
Occupational Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 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 IDStateProvider typePAC IDDetails
O20210115001356 MO Part B Supplier - Mass Immunization (Roster Biller Only) 9931512795 Practice locations: Columbia, 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
26D0992249Occupational Medicine of Mid Missouri401 N Keene Street, Columbia, MO 65201Certificate of waiverOct 10, 2027

National Provider Directory

National Provider Directory

NPI 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.

Verify at the official NPI Registry.