NPIMap

Individual provider Active NPI

Michael Thomas Rothermich, M.D.

  • Family Medicine Physician
  • Montgomery City, MO
National Provider Identifier
1629063524
Registry record updated Feb 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2002011778 Issued in MO
Practice address
504 N Sturgeon St
Montgomery City, MO 63361-1829
Phone
(573) 564-2990
NPI assigned
Sep 16, 2005
Last updated
Feb 8, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2002011778 MO Primary

Addresses

Primary practice location

504 N Sturgeon St
Montgomery City, MO 63361-1829

Mailing address

PO Box 19
Hermann, MO 65041-0019
Phone (573) 486-1193

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
I20070430000150 MO Practitioner - Family Practice 0547366023 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Missouri, Columbia School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hermann Area Hospital DistrictGroup PAC ID 5496669962, 16 clinicians

Practice addresses (Care Compare)

509 W 18TH St
Hermann, MO 65041-1547
Phone (573) 486-2191

509 W 18TH St PO Box
Suite 470
Hermann, MO 65041-1547

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hermann Area Hospital District Family Medicine CurrentSince Nov 1, 2006 Accepting new patients
Hermann Area Hospital District CurrentSince Nov 1, 2006 Accepting new patients
Eldercare of Mid-Missouri Xiii Inc. Past Accepting new patients
Hermann Area Hospital District Past Accepting new patients

Locations

123 Bavarian Hills Plz
Hermann, MO 65041
Phone (573) 486-2118

509 W 18th St
Hermann, MO 65041
Phone (573) 486-2045

504 N Sturgeon St
Montgomery City, MO 63361
Phone (573) 564-2990

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/f62890b5-77ff-44bd-a981-0a0981047b35/

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Stonebridge HermannHermann, MO, CCN 265651 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2021
Jan 1, 2021
GentivaJefferson City, MO, CCN 261684 Hospice Contracted Managing Employee May 1, 2016

Owned or controlled facilities with NPI records 2

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

Organizations & group practices 4

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 7

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": "1328659200000",
    "number": "1629063524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19",
            "city": "HERMANN",
            "state": "MO",
            "postal_code": "650410019",
            "telephone_number": "573-486-1193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 N STURGEON ST",
            "city": "MONTGOMERY CITY",
            "state": "MO",
            "postal_code": "633611829",
            "telephone_number": "573-564-2990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTHERMICH",
        "first_name": "MICHAEL",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-16",
        "last_updated": "2012-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2002011778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery City, MO

Sources for this page

Verify at the official NPI Registry.