NPIMap

Individual provider Active NPI

Clint L Vanlandingham, DPM

  • Podiatrist
  • Poplar Bluff, MO
National Provider Identifier
1508838566
Registry record updated Jan 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
2004001321 Issued in MO
Practice address
2600 Kanell Blvd
Poplar Bluff, MO 63901-3001
Phone
(573) 785-4546
Fax
(573) 785-6959
NPI assigned
Feb 3, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 27, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2014037662 MO
Podiatrist 213E00000X 2004001321 MO Primary
Foot & Ankle Surgery Podiatrist 213ES0103X 2004001321 MO

Addresses

Primary practice location

2600 Kanell Blvd
Poplar Bluff, MO 63901-3001

Mailing address

2600 Kanell Blvd
Poplar Bluff, MO 63901-3001
Phone (573) 785-4546

Other identifiers 1

IdentifierTypeStateIssuer
309166510MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040615001819 MO Practitioner - Podiatry 7719961937 Receives reassigned benefits from 8 practitioners
Practice locations: Poplar Bluff, MO

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Barry University School of Podiatric Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Health Facilities Rehab Services IncGroup PAC ID 3476679226, 152 clinicians

Practice addresses (Care Compare)

1102 Sikes Ave
Sikeston, MO 63801-5021

2600 Kanell Blvd
Poplar Bluff, MO 63901-3001
Phone (573) 785-4546

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue542
Removal of skin lesions1-10
Removal of nail tissue2425
Removal or shaving of skin growth632
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2014037662MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Clint Vanlandingham Podiatrist CurrentSince Jul 16, 2005 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

2600 Kanell Blvd
Poplar Bluff, MO 63901
Phone (573) 785-4546

223 Physicians Park
Poplar Bluff, MO 63901
Phone (573) 331-3000

225 Physicians Park
Ste 102
Poplar Bluff, MO 63901
Phone (573) 651-1882

Practitioners & affiliated clinicians

Practitioners 8

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

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580083200000",
    "number": "1508838566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 KANELL BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013001",
            "telephone_number": "573-785-4546",
            "fax_number": "573-785-6959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 KANELL BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013001",
            "telephone_number": "573-785-4546",
            "fax_number": "573-785-6959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANLANDINGHAM",
        "first_name": "CLINT",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2014037662",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MO",
            "license": "2004001321",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MO",
            "license": "2004001321",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "309166510",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poplar Bluff, MO

Sources for this page

Verify at the official NPI Registry.