NPIMap

Individual provider Active NPI

Dennis C Luetkemeyer, M.D.

  • Diagnostic Radiology Physician
  • Jefferson City, MO
National Provider Identifier
1649378597
Registry record updated Dec 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
108356 Issued in MO
Practice address
1705 Christy Dr
Suite #104
Jefferson City, MO 65101-5195
Phone
(573) 659-5580
Fax
(573) 659-5585
NPI assigned
Sep 21, 2006
Last updated
Dec 28, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 108356 MO Primary

Addresses

Primary practice location

1705 Christy Dr
Suite #104
Jefferson City, MO 65101-5195

Mailing address

1705 Christy Dr
Suite #104
Jefferson City, MO 65101-5195
Phone (573) 659-5580

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
I20040428000903 MO Practitioner - Diagnostic Radiology 7416944772 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Missouri, Columbia School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ernst Radiology Clinic, IncGroup PAC ID 2961488366, 20 clinicians
SSM Regional Health ServicesGroup PAC ID 8921917352, 165 clinicians

Practice addresses (Care Compare)

12303 Depaul Dr
Bridgeton, MO 63044-2512
Phone (314) 344-6350

2505 Mission Dr
Jefferson City, MO 65109-9508
Phone (573) 681-3000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
108356MOMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ernst Radiology Clinic, Inc Diagnostic Radiology CurrentSince Oct 1, 2022 Accepting new patients
Ernst Radiology Clinic, Inc Diagnostic Radiology CurrentSince Aug 5, 2022 Accepting new patients
Missouri Medical Imaging, Inc. Diagnostic Radiology Past Accepting new patients
Heartland Radiology, Inc. Diagnostic Radiology Past Accepting new patients
Poplar Bluff Regional Medical Center LLC Past Accepting new patients
Ozarks Medical Center Diagnostic Radiology Past Accepting new patients
SSM Regional Health Services PastSince Apr 8, 2026 Accepting new patients

Locations

12303 De Paul Dr
Bridgeton, MO 63044
Phone (314) 344-6360

3440 De Paul Ln
Bridgeton, MO 63044
Phone (314) 595-6800

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

1509 Union Ave
Moberly, MO 65270
Phone (660) 263-2986

1515 Union Ave
Moberly, MO 65270
Phone (660) 263-2400

Organizations & group practices 8

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 5

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": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198800000000",
    "number": "1649378597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 CHRISTY DR",
            "address_2": "SUITE #104",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651015195",
            "telephone_number": "573-659-5580",
            "fax_number": "573-659-5585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 CHRISTY DR",
            "address_2": "SUITE #104",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651015195",
            "telephone_number": "573-659-5580",
            "fax_number": "573-659-5585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUETKEMEYER",
        "first_name": "DENNIS",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2007-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "108356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson City, MO

Sources for this page

Verify at the official NPI Registry.