NPIMap

Individual provider Active NPI

Jessica Renee King, MD

  • Family Medicine Physician
  • Mountain Grove, MO
National Provider Identifier
1649434200
Registry record updated Apr 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2009020461 Issued in MO
Practice address
1905 W 19TH St
Mountain Grove, MO 65711-1287
Phone
(417) 926-1770
Fax
(417) 926-1785
NPI assigned
Jul 14, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2008017836 MO
Family Medicine Physician 207Q00000X 2009020461 MO Primary

Addresses

Primary practice location

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

Mailing address

1905 W 19TH St
Mountain Grove, MO 65711-1287
Phone (417) 926-1770

Other practice location 1

1337 S Sam Houston Blvd
Houston, MO 65483-2046
Phone (417) 967-5435

Other practice location 2

3525 S National Ave Ste 207
Springfield, MO 65807-7315
Phone (417) 269-9220

Other identifiers 9

IdentifierTypeStateIssuer
26D2006074OtherMOCLIA
504114802MedicaidMO
26D0889777OtherMOCLIA
1649434200MedicaidMO
594438806MedicaidMO
507780302MedicaidMO
204253207MedicaidMO
597780303MedicaidMO
P01296849OtherMORAILROAD MEDICARE

Other names 1

  • Dr. Jessica Renee Van Bibber Former name

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
I20100630000472 MO Practitioner - Family Practice 6608907977 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Missouri, Kansas City, School of Medicine, 2008
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)

1010 E Scenic Rivers Blvd
Salem, MO 65560-2820
Phone (573) 729-3106

120 W 16TH St
MC Family Medicine Mountain Grove
Mountain Grove, MO 65711-1039
Phone (417) 926-6111

1202 E Main St
MC Family Medicine Willow Springs
Willow Springs, MO 65793-3588
Phone (417) 469-1820

1605 Martin Springs Dr
Rolla, MO 65401-2980

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2008017836MOMDFamily Medicine Physician
2009020461MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas County Memorial Hospital Family Medicine CurrentSince Apr 23, 2020 Accepting new patients
Mercy Clinic Springfield Communities Family Medicine CurrentSince May 1, 2024 Accepting new patients
Dent County Health Center CurrentSince Jan 1, 2023 Accepting new patients
Mercy Clinic Springfield Communities Family Medicine CurrentSince May 1, 2024 Accepting new patients
Texas County Memorial Hospital CurrentSince Aug 13, 2022 Accepting new patients
Texas County Memorial Hospital CurrentSince Apr 23, 2020 Accepting new patients
Mercy Clinic Springfield Communities Family Medicine CurrentSince May 1, 2024 Accepting new patients
Texas County Memorial Hospital CurrentSince Apr 23, 2020 Accepting new patients
Texas County Memorial Hospital Past Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients
Texas County Memorial Hospital Past Accepting new patients

Locations

1337 S Sam Houston Blvd
Houston, MO 65483
Phone (417) 967-5435

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

1335 S Sam Houston Blvd
Houston, MO 65483
Phone (417) 967-5639

139 W Highway 32
Licking, MO 65542
Phone (573) 674-3011

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

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

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

1010 E Scenic Rivers Blvd
Salem, MO 65560
Phone (573) 729-3106

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

3801 S National Ave
Springfield, MO 65807
Phone (417) 269-4056

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1215993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588118400000",
    "number": "1649434200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": [
        {
            "address_1": "1337 S Sam Houston Blvd",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "MO",
            "postal_code": "654832046",
            "country_code": "US",
            "telephone_number": "417-967-5435",
            "fax_number": "417-967-5503",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3525 S National Ave Ste 207",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658077315",
            "country_code": "US",
            "telephone_number": "417-269-9220",
            "fax_number": "417-269-9229",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KING",
        "first_name": "JESSICA",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-14",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2008017836",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2009020461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26D2006074",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "504114802",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26D0889777",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649434200",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "594438806",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507780302",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204253207",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "597780303",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01296849",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "VAN BIBBER",
            "middle_name": "RENEE",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mountain Grove, MO

Sources for this page

Verify at the official NPI Registry.