Jordan Bryan Lane, DO

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2022025223 Issued in MO

Practice address

1100 N Kentucky Ave
West Plains, MO 65775-2029

Phone

(417) 256-9111

NPI assigned

Apr 5, 2021

Last updated

Jul 6, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

New York College of Osteo Medicine of New York Institute of Technology, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ozarks Medical CenterGroup PAC ID 3870491863, 166 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ozarks Healthcare Hospital, West Plains, MO, CCN 260078

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jbl@cleaver.emadirect.md

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.

• Ozarks Medical Center

  dba Ozarks Healthcare

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641

  Dermatology

  Medicare reassignment Care Compare group NPD
• Ozarks Medical Center

  • Psychiatric Hospital Unit
  • West Plains, MO
  • NPI 1235929027
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ozarks Medical Center

  dba Ozarks Healthcare

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  Care Compare affiliation

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

{
    "created_epoch": "1617580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751760000000",
    "number": "1639758006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 N KENTUCKY AVE",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657752029",
            "telephone_number": "417-256-9111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N KENTUCKY AVE",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657752029",
            "telephone_number": "417-256-9111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 S Osteopathy Ave",
            "address_purpose": "LOCATION",
            "city": "Kirksville",
            "state": "MO",
            "postal_code": "635016401",
            "country_code": "US",
            "telephone_number": "660-785-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANE",
        "first_name": "JORDAN",
        "middle_name": "BRYAN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-05",
        "last_updated": "2025-07-06",
        "certification_date": "2025-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MO",
            "license": "2022025223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa Kusmaul, TREATMENT TECH
• Carrie Ann Laird
• Donald Wayne Lamoureaux, D.O.
• Lamplight Village LLC
• Lamplight Village LLC
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• Zachary Latta
• Kelly Lawing
• Donna Kathleen Lay, LPC
• Khoa Le, MD

• Dermatology Physician in West Plains, MO
• Providers in West Plains, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.