NPIMap

Organization Active NPI

Ozarks Medical Center

Doing business as Ozarks Medical Center Nephrology Clinic

  • Nephrology Physician
  • West Plains, MO
National Provider Identifier
1649569740
Registry record updated Feb 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
OZARKS MEDICAL CENTER
Doing business as
Ozarks Medical Center Nephrology Clinic
Practice address
3000 Independence SQ
West Plains, MO 65775-4239
Phone
(417) 256-1731
Fax
(417) 256-1733
NPI assigned
Mar 30, 2011
Last updated
Feb 18, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2014

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

Authorized official

Name
Thomas W Keller
Title
President and Ceo
Phone
(417) 256-9111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

3000 Independence SQ
West Plains, MO 65775-4239

Mailing address

PO Box 1100
West Plains, MO 65775-1100

Other names 1

  • Ozarks Medical Center Nephrology Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040209001035 MO Part B Supplier - Clinic/Group Practice 3870491863 Receives reassigned benefits from 353 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Plains, MO; Winona, MO; Willow Springs, MO; Gainesville, MO; Houston, MO; Mountain Grove, MO; Mountain View, MO; Thayer, MO

Other NPIs on the same Medicare enrollment 28

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 28

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1301443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392681600000",
    "number": "1649569740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1100",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657751100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 INDEPENDENCE SQ",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657754239",
            "telephone_number": "417-256-1731",
            "fax_number": "417-256-1733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OZARKS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-30",
        "last_updated": "2014-02-18",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "417-256-9111"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ozarks Medical Center Nephrology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Plains, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.