Southeast Missouri Hospital Physicians, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SOUTHEAST MISSOURI HOSPITAL PHYSICIANS, LLC

Doing business as

Mercy Clinic Southeast

Practice address

1701 Lacey St
Cape Girardeau, MO 63701-5230

Phone

(573) 331-6880

Fax

(573) 331-6887

NPI assigned

May 11, 2006

Last updated

Jan 13, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Krista Berry

Title

Cfo

Phone

(573) 331-6028

Specialties & licenses 15

Addresses

Other identifiers 1

Other names 1

• MERCY CLINIC SOUTHEAST Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Southeast Missouri Hospital Physicians LLC

  dba Mercy Southeast Pediatrics

  • Rural Health Clinic/Center
  • Cape Girardeau, MO
  • NPI 1619245503

  9133024334

  Same PAC ID
• Southeast Missouri Hospital Physicians LLC

  dba Mercy Southeast Primary Care West

  • Rural Health Clinic/Center
  • Cape Girardeau, MO
  • NPI 1699073122

  9133024334

  Same PAC ID

Locations

Practitioners 491

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.

• Ensaf Alhujaily, MD

  • Internal Medicine Physician
  • Cape Girardeau, MO
  • NPI 1346980349
  Medicare reassignment Care Compare group NPD
• Sajjad Ali

  • Internal Medicine Physician
  • Cape Girardeau, MO
  • NPI 1851742092
  Medicare reassignment Care Compare group NPD
• Darren Michael Allcock, D.O.

  • Endocrinology, Diabetes & Metabolism Physician
  • Cape Girardeau, MO
  • NPI 1225149990
  Medicare reassignment Care Compare group NPD
• William S Anast, MD

  • Anesthesiology Physician
  • Rolla, MO
  • NPI 1124024468
  Medicare reassignment Care Compare group NPD
• Michelle Ann Backfisch, CNP

  • Family Nurse Practitioner
  • Scott City, MO
  • NPI 1639731474
  Medicare reassignment Care Compare group NPD
• Matthew Baker, MD

  • Orthopaedic Surgery Physician
  • Festus, MO
  • NPI 1386888527
  Medicare reassignment Care Compare group NPD
• Alexandria M Barker, FNP

  • Family Nurse Practitioner
  • Sikeston, MO
  • NPI 1891270666
  Medicare reassignment Care Compare group NPD
• Lindsey Baumhoer

  • Family Nurse Practitioner
  • Cape Girardeau, MO
  • NPI 1376095380
  Medicare reassignment Care Compare group NPD
• Bryan S Beck, MD

  • Cardiovascular Disease Physician
  • Cape Girardeau, MO
  • NPI 1720018179
  Medicare reassignment Care Compare group NPD
• Erika Beussink

  • Certified Registered Nurse Anesthetist
  • Cape Girardeau, MO
  • NPI 1255828638

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Katana M Boyd

  • Family Nurse Practitioner
  • Cape Girardeau, MO
  • NPI 1073052296
  Medicare reassignment Care Compare group NPD
• Randy G Brown, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Cape Girardeau, MO
  • NPI 1134218662
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705104000000",
    "number": "1558311522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 LACEY ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637015230",
            "telephone_number": "573-331-6880",
            "fax_number": "573-331-6887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 LACEY ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637015230",
            "telephone_number": "573-331-6880",
            "fax_number": "573-331-6887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MISSOURI HOSPITAL PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2024-01-13",
        "certification_date": "2024-01-13",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-331-6028"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "505394007",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERCY CLINIC SOUTHEAST",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Southeast Missouri Area Agency on Aging, Inc. (Aging Matters)
• Southeast Missouri Area Agency on Aging, Inc. (Aging Matters)
• Southeast Missouri Hospital Physicians LLC (Mercy Southeast Pediatrics)
• Southeast Missouri Hospital Physicians LLC (Mercy Southeast Primary Care West)
• Southeast Missouri Hospital Physicians LLC (Southeast Primary Care - Broadway)
• Southeast Missouri Oral & Maxillofacial Surgery
• Southeast Missouri State University (Horizons Enrichment Center)
• Southeast Missouri State University (Horizons Enrichment Center)
• Southeast Missouri State University (SEMO State Sports Medicine)
• Southeast Missouri State University Autism Center

• Family Medicine Physician in Cape Girardeau, MO
• Providers in Cape Girardeau, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.