Great Mines Health Center

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

GREAT MINES HEALTH CENTER

Practice address

123 W Pratt St
De Soto, MO 63020-2107

Phone

(636) 586-2522

Fax

(636) 586-2546

NPI assigned

Dec 3, 2007

Last updated

Feb 4, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Donna L Blount

Title

Office Manager

Phone

(573) 438-9355

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669654638. Details of each certification follow.

• CCN 261021 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 261021

Legal name

GREAT MINES HEALTH CENTER-DESOTO

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Mar 3, 2008

Last certification

Mar 3, 2008

Ownership / control type

Non-profit – church related

Facility address

123 West Pratt Street
De Soto, MO 63020

Other NPIs on the same Medicare enrollment 5

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

• Great Mines Health Center

  • Federally Qualified Health Center (FQHC)
  • Potosi, MO
  • NPI 1376536953

  O20041004000035

  Same enrollment
• Great Mines Health Center

  • Federally Qualified Health Center (FQHC)
  • Cadet, MO
  • NPI 1548750847

  O20041004000035

  Same enrollment
• Great Mines Health Center

  • Federally Qualified Health Center (FQHC)
  • Farmington, MO
  • NPI 1750563722

  O20041004000035

  Same enrollment
• Great Mines Health Center

  • Federally Qualified Health Center (FQHC)
  • Mineral Point, MO
  • NPI 1891341665

  O20041004000035

  Same enrollment
• Great Mines Health Center

  • Federally Qualified Health Center (FQHC)
  • Farmington, MO
  • NPI 1922446384

  O20041004000035

  Same enrollment

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

{
    "created_epoch": "1196640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202083200000",
    "number": "1669654638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 W PRATT ST",
            "city": "DE SOTO",
            "state": "MO",
            "postal_code": "630202107",
            "telephone_number": "636-586-2522",
            "fax_number": "636-586-2546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 W PRATT ST",
            "city": "DE SOTO",
            "state": "MO",
            "postal_code": "630202107",
            "telephone_number": "636-586-2522",
            "fax_number": "636-586-2546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT MINES HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-03",
        "last_updated": "2008-02-04",
        "status": "A",
        "authorized_official_last_name": "BLOUNT",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "573-438-9355",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in De Soto, MO
• Providers in De Soto, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.