NPIMap

Individual provider Active NPI

Susan Lynn Jolly, M.D.

  • Orthopaedic Surgery Physician
  • West Plains, MO
National Provider Identifier
1598750366
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
2015013479 Issued in MO
Practice address
1100 N Kentucky Ave
West Plains, MO 65775-2029
Phone
(417) 256-9111
Fax
(417) 256-1746
NPI assigned
Sep 16, 2005
Last updated
Jul 17, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 29220 CO
Orthopaedic Surgery Physician 207X00000X 2015013479 MO Primary
Orthopaedic Surgery Physician 207X00000X 29220 CO

Addresses

Primary practice location

1100 N Kentucky Ave
West Plains, MO 65775-2029

Mailing address

1210 N. Kentucky
West Plains, MO 65775
Phone (417) 256-1745

Other identifiers 3

IdentifierTypeStateIssuer
01292200MedicaidCO
2015013479OtherMOMISSOURI MEDICAL LICENSE
29220OtherCOLICENSE

Other names 1

  • Susan Lynn Jolly Dyer Other name

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
I20150720002059 MO Practitioner - Orthopedic Surgery 7416855309 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Ohio State University College of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ozarks Medical CenterGroup PAC ID 3870491863, 166 clinicians

Practice addresses (Care Compare)

1100 N Kentucky Ave
West Plains, MO 65775-2029

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.96 of 100Reported as group
Quality
78.58
Promoting interoperability
99
Improvement activities
40
Cost
77.82

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Knee replacement13
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29220COMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Ozarks Medical Center CurrentSince Jun 10, 2015 Accepting new patients
Ozarks Medical Center CurrentSince Jun 10, 2015 Accepting new patients
Mile Hi Orthopaedics and Rehab, Inc. Orthopaedic Surgery Past Accepting new patients
Summit View Surgery Center, LLC PastSince Apr 30, 2003 Accepting new patients
Littleton Orthopaedic Associates PC Orthopaedic Surgery PastSince Jan 1, 2006 Accepting new patients

Locations

1100 N Kentucky Ave
West Plains, MO 65775
Phone (417) 257-5959

1210 N Kentucky Ave
West Plains, MO 65775
Phone (417) 256-1745

1609 Porter Wagoner Blvd
West Plains, MO 65775
Phone (417) 255-2880

Interoperability endpoints

  • Direct secure messaging: dr.jolly@mhccaremail.com
  • Direct secure messaging: susanjolly@omcmo.allscriptsdirect.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ozarks HealthcareWest Plains, MO, CCN 260078 Hospital Corporate Officer Jan 1, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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

Hospital & facility affiliations 4

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": "1126828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1598750366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 N. KENTUCKY",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "65775",
            "telephone_number": "417-256-1745",
            "fax_number": "417-256-1746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N KENTUCKY AVE",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657752029",
            "telephone_number": "417-256-9111",
            "fax_number": "417-256-1746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOLLY",
        "first_name": "SUSAN",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-16",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CO",
            "license": "29220",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MO",
            "license": "2015013479",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CO",
            "license": "29220",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01292200",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI MEDICAL LICENSE",
            "identifier": "2015013479",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "29220",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "JOLLY DYER",
            "middle_name": "LYNN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in West Plains, MO

Sources for this page

Verify at the official NPI Registry.