NPIMap

Individual provider Active NPI

Trevor Doren, PA

  • Physician Assistant
  • Springfield, MO
National Provider Identifier
1639707912
Registry record updated Mar 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2021019987 Issued in MO
Practice address
2115 S Fremont Ave Ste 3300
Springfield, MO 65804-2246
Phone
(417) 820-5200
NPI assigned
Mar 31, 2020
Last updated
Mar 31, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 31, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 20041100227 MI
Physician Assistant 363A00000X 2021019987 MO Primary

Addresses

Primary practice location

2115 S Fremont Ave Ste 3300
Springfield, MO 65804-2246

Mailing address

2115 S Fremont Ave Ste 3300
Springfield, MO 65804-2246
Phone (417) 820-5200

Other practice location 1

813 braastads road
Ishpeming, MI 49849
Phone (517) 292-9913

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
I20210818001144 MO Practitioner - Physician Assistant 2466857131 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

1235 E Cherokee St
Springfield, MO 65804-2203

2115 S Fremont Ave
3050 MC Infectious Disease Whiteside
Springfield, MO 65804-2236
Phone (417) 820-3905

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
20041100227MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Apr 3, 2023 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Apr 3, 2023 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Apr 3, 2023 Accepting new patients

Locations

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

2115 S Fremont Ave
Ste 3300
Springfield, MO 65804
Phone (417) 820-5200

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

Hospital & facility affiliations 9

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": "1585612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680220800000",
    "number": "1639707912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2115 S FREMONT AVE STE 3300",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042246",
            "telephone_number": "417-820-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 S FREMONT AVE STE 3300",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042246",
            "telephone_number": "417-820-5200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "813 braastads road",
            "address_purpose": "LOCATION",
            "city": "ISHPEMING",
            "state": "MI",
            "postal_code": "49849",
            "country_code": "US",
            "telephone_number": "517-292-9913",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOREN",
        "first_name": "TREVOR",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-31",
        "last_updated": "2023-03-31",
        "certification_date": "2023-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "20041100227",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2021019987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.