NPIMap

Individual provider Active NPI

Andrew John Ninichuck, M.D.

  • General Practice Physician
  • Bonne Terre, MO
National Provider Identifier
1609841956
Registry record updated Nov 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
102387 Issued in MO
Practice address
527 Benham St
Bonne Terre, MO 63628-1205
Phone
(573) 358-9119
Fax
(573) 358-9489
NPI assigned
Feb 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 10, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 102387 MO Primary

Addresses

Primary practice location

527 Benham St
Bonne Terre, MO 63628-1205

Mailing address

527 Benham St
Bonne Terre, MO 63628-1205
Phone (573) 358-9119

Other identifiers 1

IdentifierTypeStateIssuer
1609841956MedicaidMO

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
I20080731000726 MO Practitioner - General PracticePractitioner - Family Practice 0749354249 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
University of Missouri, Columbia School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

200 Health Way Dr
Healthway Primary Care
Potosi, MO 63664-1434
Phone 5734385451355

300 Health Way
Potosi, MO 63664-1420

300 Health Way Dr
Potosi, MO 63664-1420
Phone 5734385451355

527 Benham St
Bonne Terre, MO 63628-1205
Phone (573) 358-9119

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
102387MOMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care of Bonne Terre LLC General Practice CurrentSince Oct 26, 2015 Accepting new patients
Washington County Memorial Hospital CurrentSince Feb 12, 2019 Accepting new patients
Washington County Memorial Hospital CurrentSince Feb 12, 2019 Accepting new patients
Washington County Memorial Hospital Past Accepting new patients
Bonne Terre Medical Associates, P.C. Past Accepting new patients

Locations

527 Benham St
Bonne Terre, MO 63628
Phone (573) 358-5577

200 Health Way Dr
Potosi, MO 63664
Phone (573) 438-2977

300 Health Way Dr
Potosi, MO 63664
Phone (573) 438-2977

Interoperability endpoints

  • Direct secure messaging: aninichuck@primarycareofbonneterre.kareodirect.com
  • Direct secure messaging: andrew.ninichuck.p1@direct.wcmh-clinics.nextgenshare.com

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447113600000",
    "number": "1609841956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 BENHAM ST",
            "city": "BONNE TERRE",
            "state": "MO",
            "postal_code": "636281205",
            "telephone_number": "573-358-9119",
            "fax_number": "573-358-9489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 BENHAM ST",
            "city": "BONNE TERRE",
            "state": "MO",
            "postal_code": "636281205",
            "telephone_number": "573-358-9119",
            "fax_number": "573-358-9489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NINICHUCK",
        "first_name": "ANDREW",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2015-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MO",
            "license": "102387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609841956",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonne Terre, MO

Sources for this page

Verify at the official NPI Registry.