NPIMap

Individual provider Active NPI

Eric Bryan Engel, PA

  • Physician Assistant
  • Ozark, MO
National Provider Identifier
1659444305
Registry record updated Sep 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2014032125 Issued in MO
Practice address
1106 W Jackson St
Ozark, MO 65721-9164
Phone
(417) 581-3548
Fax
(417) 581-6164
NPI assigned
Nov 17, 2006
Last updated
Sep 22, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2014032125 MO Primary

Addresses

Primary practice location

1106 W Jackson St
Ozark, MO 65721-9164

Mailing address

PO Box 505164
Saint Louis, MO 63150-5164
Phone (417) 829-4620

Other identifiers 2

IdentifierTypeStateIssuer
8Y2074OtherTXBCBS
188436301MedicaidTX

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
I20141013002506 MO Practitioner - Physician Assistant 2466554035 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Texas Tech University Health Science Center School of Medicine, 2006
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)

1605 Martin Springs Dr
Rolla, MO 65401-2980

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

2716 W Republic Rd
Family Medicine Scenic
Springfield, MO 65807-3901
Phone (417) 881-8812

3231 S National Ave
Springfield, MO 65807-7304

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2014032125MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities Physician Assistant CurrentSince Sep 15, 2014 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Apr 1, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Sep 15, 2014 Accepting new patients

Locations

1106 W Jackson St
Ozark, MO 65721
Phone (417) 581-3548

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

1605 Martin Springs Dr
Ste 330
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

Interoperability endpoints

  • Direct secure messaging: eengel496093@directb.mercy.net

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": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411344000000",
    "number": "1659444305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 505164",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631505164",
            "telephone_number": "417-829-4620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 W JACKSON ST",
            "city": "OZARK",
            "state": "MO",
            "postal_code": "657219164",
            "telephone_number": "417-581-3548",
            "fax_number": "417-581-6164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENGEL",
        "first_name": "ERIC",
        "middle_name": "BRYAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2014-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2014032125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8Y2074",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "188436301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ozark, MO

Sources for this page

Verify at the official NPI Registry.