NPIMap

Individual provider Active NPI

Elizabeth Logan, D.O.

  • Family Medicine Physician
  • Clinton, MO
National Provider Identifier
1528036324
Registry record updated Nov 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R8N38 Issued in MO
Practice address
1602 N 2ND St
Clinton, MO 64735-1192
Phone
(660) 885-8171
Fax
(660) 890-8487
NPI assigned
Mar 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R8N38 MO Primary

Addresses

Primary practice location

1602 N 2ND St
Clinton, MO 64735-1192

Mailing address

1602 N 2ND St
Clinton, MO 64735-1192
Phone (660) 885-8171

Other names 1

  • Dr. Elizabeth Fassler Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address elizabethlogan@mhccaremail.com

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
I20040504000765 MO Practitioner - Family Practice 3274521711 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Golden Valley Memorial Hospital DistrictGroup PAC ID 4688561814, 138 clinicians

Practice addresses (Care Compare)

1600 N 2ND St
Clinton, MO 64735-1192
Phone (660) 885-5511

1602 N 2ND St
Clinton, MO 64735-1192

Hospital & facility affiliations

  • Novus Lifecare Home health agency, Clinton, MO, CCN 267182
  • Novus Lifecare Hospice, Clinton, MO, CCN 261514
  • Golden Valley Memorial Hospital Hospital, Clinton, MO, CCN 260175
  • Clinton Healthcare and Rehabilitation Center Nursing home, Clinton, MO, CCN 265255
  • Adair Village Nursing home, Clinton, MO, CCN 265347

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
R8N38MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Golden Valley Memorial Hospital District CurrentSince Apr 1, 2004 Accepting new patients
Golden Valley Memorial Hospital District CurrentSince Apr 1, 2004 Accepting new patients
Golden Valley Memorial Hospital District Past Accepting new patients
Truman Valley Health Care, Inc. Past Accepting new patients
Clinton No 2 Inc Past Accepting new patients
Clinton No 1 Inc Past Accepting new patients

Locations

1602 N 2nd St
Clinton, MO 64735
Phone (660) 885-8171

1600 N 2nd St
Clinton, MO 64735
Phone (660) 885-8171

1701 N 2nd St
Clinton, MO 64735
Phone (660) 885-8171

Organizations & group practices 6

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": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1528036324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 N 2ND ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647351192",
            "telephone_number": "660-885-8171",
            "fax_number": "660-890-8487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 N 2ND ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647351192",
            "telephone_number": "660-885-8171",
            "fax_number": "660-890-8487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-09",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R8N38",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "elizabethlogan@mhccaremail.com",
            "affiliation": "N",
            "address_1": "1602 N 2nd St",
            "city": "Clinton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "647351192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "FASSLER",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Clinton, MO

Sources for this page

Verify at the official NPI Registry.