Emologic Clinic, LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

2005034472 Issued in MO

Legal business name

EMOLOGIC CLINIC, LLC

Practice address

500 W. Main
Ste 204
Branson, MO 65616

Phone

(417) 243-7777

Fax

(417) 243-7778

NPI assigned

Jul 24, 2013

Last updated

Jul 24, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

EMOLOGIC CLINIC LLCAs reported in NPPES

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

Authorized official

Name

Mr. Shahid Insaf, M.D.NPI 1174666044

Title

Owner/Psychiatrist

Phone

(417) 243-7777

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Emologic Clinic LLC

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Layna Marie Brantner, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Branson, MO
  • NPI 1811659683
  Medicare reassignment NPD
• Shahid S Insaf, MD

  • Psychiatry Physician
  • Branson, MO
  • NPI 1174666044
  NPD Authorized official
• Paula Lynne Wiesehan, FNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Bremerton, WA
  • NPI 1144348954
  NPD (past)

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

{
    "created_epoch": "1374624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374624000000",
    "number": "1528400173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W. MAIN",
            "address_2": "STE 204",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "65616",
            "telephone_number": "417-243-7777",
            "fax_number": "417-243-7778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W. MAIN",
            "address_2": "STE 204",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "65616",
            "telephone_number": "417-243-7777",
            "fax_number": "417-243-7778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMOLOGIC CLINIC, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMOLOGIC CLINIC LLC",
        "enumeration_date": "2013-07-24",
        "last_updated": "2013-07-24",
        "status": "A",
        "authorized_official_last_name": "INSAF",
        "authorized_official_first_name": "SHAHID",
        "authorized_official_title_or_position": "OWNER/PSYCHIATRIST",
        "authorized_official_telephone_number": "417-243-7777",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "MO",
            "license": "2011026917",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "2005034472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Branson, MO
• Providers in Branson, MO by specialty
• Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; 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.