C. Tucker Joustra Family Practice, Inc.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

R9G86 Issued in MO

Legal business name

C. TUCKER JOUSTRA FAMILY PRACTICE, INC.

Practice address

805 Gulf St
Lamar, MO 64759-1238

Phone

(417) 682-5508

Fax

(417) 682-5594

NPI assigned

Feb 8, 2010

Last updated

Feb 8, 2010By 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

Clarence Tucker Joustra, D.O.NPI 1942202080

Title

President

Phone

(417) 682-5508

Specialties & licenses 1

Addresses

Other identifiers 1

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

Locations

Practitioners 2

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.

• Clarence Tucker Joustra, DO

  • Family Medicine Physician
  • Lamar, MO
  • NPI 1942202080
  Medicare reassignment NPD Authorized official
• Kristin C Robertson, RN FNP-C

  • Critical Care Medicine Nurse Practitioner
  • Lamar, MO
  • NPI 1003949587
  Medicare reassignment NPD

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

{
    "created_epoch": "1265587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265587200000",
    "number": "1609108240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 GULF ST",
            "city": "LAMAR",
            "state": "MO",
            "postal_code": "647591238",
            "telephone_number": "417-682-5508",
            "fax_number": "417-682-5594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 GULF ST",
            "city": "LAMAR",
            "state": "MO",
            "postal_code": "647591238",
            "telephone_number": "417-682-5508",
            "fax_number": "417-682-5594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C. TUCKER JOUSTRA FAMILY PRACTICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-08",
        "last_updated": "2010-02-08",
        "status": "A",
        "authorized_official_last_name": "JOUSTRA",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_middle_name": "TUCKER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "417-682-5508",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MO",
            "license": "R9G86",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "242426534",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Beth Bronson, FNP-C
• David Edward Brown, D.O.
• Tammy Brown, PLPC
• Kylie Dawn Bryant
• Erica S. Burton, OD
• Brett Brewster Campbell
• CBCH LLC
• Jonni Marie Chapple, LMSW
• Chynna Paige Compton, MSN, APRN, FNP-C
• David Bryan Compton, MS, ATC, LAT

• Primary Care Clinic/Center in Lamar, MO
• Providers in Lamar, MO by specialty
• Primary Care Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2010; 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.