Active NPI
Damasus S. Jayamanne, M.D.
- Pulmonary Disease Physician
- Jefferson City, MO
National Provider Identifier
1619953833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- R1J19
- Practice address
- 1241 W Stadium Blvd
Jefferson City, MO 65109-6023 - Phone
- (573) 635-5264
- Fax
- (573) 761-4351
- NPI assigned
- Dec 20, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | R1J19 | MO | |
| Pulmonary Disease Physician | 207RP1001X | R1J19 | MO | Primary |
Addresses
Primary practice location
1241 W Stadium Blvd
Jefferson City, MO 65109-6023
Mailing address
PO Box 104240
Jefferson City, MO 65110-4240
Phone (573) 635-5264
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 189447 | Other | HEALTHLINK | |
| 110042202 | Other | MO | MEDICARE RAILROAD |
| CC7852 | Other | MO | RR GROUP |
| 202560215 | Medicaid | MO | |
| 11650 | Other | MO | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R1J19 | MO | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jefferson City Medical Group, P.C. | Current | Accepting new patients | |
| Jefferson City Medical Group, P.C. | Current | Accepting new patients | |
| Jefferson City Medical Group, P.C. | Current | Accepting new patients |
Locations
1241 W Stadium Blvd
#L400B
Jefferson Cty, MO 65109
Phone (573) 556-7724
1241 W Stadium Blvd
Jefferson Cty, MO 65109
Phone (573) 556-5771
1125 Madison St
Jefferson Cty, MO 65101
Phone (573) 632-5000
Organizations & group practices 3
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.
-
- Hematology & Oncology Physician
- Jefferson City, MO
- NPI 1215093257
-
- Multi-Specialty Clinic/Center
- Jefferson City, MO
- NPI 1336189398
-
- Clinical Medical Laboratory
- Jefferson City, MO
- NPI 1811292105
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217462400000",
"number": "1619953833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 104240",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651104240",
"telephone_number": "573-635-5264",
"fax_number": "573-761-4351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1241 W STADIUM BLVD",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651096023",
"telephone_number": "573-635-5264",
"fax_number": "573-761-4351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAYAMANNE",
"first_name": "DAMASUS",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-20",
"last_updated": "2008-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MO",
"license": "R1J19",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "MO",
"license": "R1J19",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "189447",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "110042202",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR GROUP",
"identifier": "CC7852",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "202560215",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "11650",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Jefferson City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.