Individual provider Active NPI

Jennifer Moss, CRNA

  • Certified Registered Nurse Anesthetist
  • Poplar Bluff, MO
National Provider Identifier
1578958377
Registry record updated May 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
2015016109 Issued in MO
Practice address
3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573
Phone
(573) 785-7721
NPI assigned
Mar 30, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 2015016109 MO Primary

Addresses

Primary practice location

3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573

Mailing address

2946 W Lakeview Dr
Poplar Bluff, MO 63901-9740

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150717002365 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 8224341300 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rural Health Pain Management LLCGroup PAC ID 8921410341, 35 clinicians

Practice addresses (Care Compare)

2620 N Westwood Blvd
Poplar Bluff, MO 63901-3396
Phone (901) 682-6828

3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573
Phone (901) 682-6828

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Health Center of Stoddard County LLC CurrentSince Dec 8, 2025 Accepting new patients
Capital Anesthesia Solutions of Missouri, LLC CurrentSince Jan 1, 2021 Accepting new patients
Southeast Health Center of Stoddard County, LLC CurrentSince Dec 8, 2025 Accepting new patients
Rural Health Pain Management LLC CurrentSince Aug 1, 2024 Accepting new patients

Locations

1200 N One Mile Rd
Dexter, MO 63841
Phone (573) 614-1900

1515 Union Ave
Moberly, MO 65270
Phone (660) 263-2400

2620 N Westwood Blvd
Poplar Bluff, MO 63901
Phone (573) 686-4111

3100 Oak Grove Rd
Rombauer, MO 63901
Phone (573) 776-2000

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 1

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": "1427673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432857600000",
    "number": "1578958377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2946 W LAKEVIEW DR",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639019740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 OAK GROVE RD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639011573",
            "telephone_number": "573-785-7721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSS",
        "first_name": "JENNIFER",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-30",
        "last_updated": "2015-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2015016109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poplar Bluff, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2015; 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.