NPIMap

Individual provider Active NPI

Brenna Stotlemeyer, PA-C

  • Physician Assistant
  • Columbia, MO
National Provider Identifier
1619738853
Registry record updated Dec 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2024039799 Issued in MO
Practice address
1600 E Broadway
Columbia, MO 65201-5844
Phone
(573) 815-8000
Fax
(573) 815-6325
NPI assigned
Jan 16, 2024
Last updated
Dec 31, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2024039799 MO Primary

Addresses

Primary practice location

1600 E Broadway
Columbia, MO 65201-5844

Mailing address

1600 E Broadway
Columbia, MO 65201-5844
Phone (573) 815-8000

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
I20241122002425 MO Practitioner - Physician Assistant 4880129154 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boone Physician Services LLCGroup PAC ID 6507090644, 243 clinicians

Practice addresses (Care Compare)

1600 E Broadway
Columbia, MO 65201-5844
Phone (573) 815-8000

1600 E Broadway Box 50 Attn Stephanie Windsor
Columbia, MO 65201-5844

1705 E Broadway
Suite 280
Columbia, MO 65201-7185
Phone (573) 815-7119

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Boone Physician Services, LLC CurrentSince Jan 13, 2025 Accepting new patients

Locations

1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000

1705 E Broadway
Ste 280
Columbia, MO 65201
Phone (573) 815-7119

Organizations & group practices 1

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 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1705363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735603200000",
    "number": "1619738853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 E BROADWAY",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652015844",
            "telephone_number": "573-815-8000",
            "fax_number": "573-815-6325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 E BROADWAY",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652015844",
            "telephone_number": "573-815-8000",
            "fax_number": "573-815-6325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOTLEMEYER",
        "first_name": "BRENNA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-16",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2024039799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.