NPIMap

Individual provider Active NPI

Elton W. Hoerning, MD

  • Family Medicine Physician
  • Mountain Grove, MO
National Provider Identifier
1629142476
Registry record updated Nov 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R5P96 Issued in MO
Practice address
1905 W 19TH St
Mountain Grove, MO 65711-1287
Phone
(417) 926-1770
Fax
(417) 926-1785
NPI assigned
Nov 20, 2006
Last updated
Nov 20, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2019

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 R5P96 MO Primary

Addresses

Primary practice location

1905 W 19TH St
Mountain Grove, MO 65711-1287

Mailing address

PO Box 702
Mountain Grove, MO 65711-0702
Phone (417) 926-2028

Other identifiers 2

IdentifierTypeStateIssuer
26D2006074OtherMOCLIA
206659112MedicaidMO

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
I20100817001294 MO Practitioner - Family Practice 3971637604 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Missouri, Columbia School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas County Memorial HospitalGroup PAC ID 9436041696, 30 clinicians

Practice addresses (Care Compare)

1905 W 19TH St
Mountain Grove, MO 65711-1287

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Texas County Memorial Hospital CurrentSince Sep 28, 2019 Accepting new patients
Texas County Memorial Hospital Family Medicine CurrentSince Sep 28, 2019 Accepting new patients
Texas County Memorial Hospital Past Accepting new patients
Texas County Memorial Hospital Family Medicine Past Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients

Locations

1333 S Sam Houston Blvd
Houston, MO 65483
Phone (417) 967-3311

1905 W 19th St
Mountain Grv, MO 65711
Phone (417) 926-1770

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574208000000",
    "number": "1629142476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 702",
            "city": "MOUNTAIN GROVE",
            "state": "MO",
            "postal_code": "657110702",
            "telephone_number": "417-926-2028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 W 19TH ST",
            "city": "MOUNTAIN GROVE",
            "state": "MO",
            "postal_code": "657111287",
            "telephone_number": "417-926-1770",
            "fax_number": "417-926-1785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOERNING",
        "first_name": "ELTON",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2019-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R5P96",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26D2006074",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206659112",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain Grove, MO

Sources for this page

Verify at the official NPI Registry.