NPIMap

Organization Active NPI

Ozark Valley Medical Clinic, LLC

  • Family Medicine Physician
  • Ozark, MO
National Provider Identifier
1639686850
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2017032792 Issued in MO
Legal business name
OZARK VALLEY MEDICAL CLINIC, LLC
Practice address
5571 N 21St St
Ozark, MO 65721-7488
Phone
(417) 317-5330
Fax
(417) 763-3370
NPI assigned
Jan 9, 2018
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
LIFT UP SOMEONE TODAYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Dr. Patricia Ashton Derges, MDNPI 1134648959
Title
Ceo/Owner
Phone
(417) 317-5330

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2017017409 MO
Family Medicine Physician 207Q00000X 2017024744 MO
Family Medicine Physician 207Q00000X 2017032792 MO Primary
Pain Medicine Physician 208VP0000X 2017032792 MO

Addresses

Primary practice location

5571 N 21St St
Ozark, MO 65721-7488

Mailing address

5571 N 21St St
Ozark, MO 65721-7488
Phone (417) 317-5330

Other practice location 1

3259 E Sunshine St Ste AA
Springfield, MO 65804-2114
Phone (417) 763-3360

Other practice location 2

2005 E Kearney St Ste K
Springfield, MO 65803-4606
Phone (417) 763-3360

Other names 1

  • Lift Up Someone Today Other name

National Provider Directory

National Provider Directory

Locations

5571 N 21st St
Ozark, MO 65721
Phone (417) 317-5330

2005 E Kearney St
Ste K
Springfield, MO 65803
Phone (417) 763-3360

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1515456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1639686850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5571 N 21ST ST",
            "city": "OZARK",
            "state": "MO",
            "postal_code": "657217488",
            "telephone_number": "417-317-5330",
            "fax_number": "417-763-3370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5571 N 21ST ST",
            "city": "OZARK",
            "state": "MO",
            "postal_code": "657217488",
            "telephone_number": "417-317-5330",
            "fax_number": "417-763-3370"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3259 E Sunshine St Ste AA",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658042114",
            "country_code": "US",
            "telephone_number": "417-763-3360",
            "fax_number": "417-763-3370",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2005 E Kearney St Ste K",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658034606",
            "country_code": "US",
            "telephone_number": "417-763-3360",
            "fax_number": "417-763-3370",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OZARK VALLEY MEDICAL CLINIC, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFT UP SOMEONE TODAY",
        "enumeration_date": "2018-01-09",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "DERGES",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "ASHTON",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "417-317-5330",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2017017409",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2017024744",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2017032792",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "MO",
            "license": "2017032792",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lift Up Someone Today",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ozark, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.