NPIMap

Organization Active NPI

Poplar Bluff Regional Medical Center, LLC

Doing business as Dexter Medical Clinic

  • Family Medicine Physician
  • Dexter, MO
National Provider Identifier
1669888681
Registry record updated Jul 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
POPLAR BLUFF REGIONAL MEDICAL CENTER, LLC
Doing business as
Dexter Medical Clinic
Practice address
610 N One Mile Rd
Dexter, MO 63841-2539
Phone
(573) 624-3600
Fax
(573) 624-4702
NPI assigned
Jul 10, 2014
Last updated
Jul 29, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
POPLAR BLUFF REGIONAL MEDICAL CENTER, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 29, 2014

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

Authorized official

Name
James P Wright
Title
Sr. Director
Phone
(615) 465-7587

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

610 N One Mile Rd
Dexter, MO 63841-2539

Mailing address

PO Box 689022
Franklin, TN 37068-9022
Phone (615) 465-7000

Other names 1

  • Dexter Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090911000300 MO Part B Supplier - Clinic/Group Practice 6800707225 Receives reassigned benefits from 14 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Poplar Bluff, MO; Dexter, MO; Malden, MO; Bloomfield, MO

Other NPIs on the same Medicare enrollment 7

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0887547Dexter Medical Clinic610 North One Mile Road, Dexter, MO 63841Certificate of waiverJul 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Three Rivers Anesthsia11 organizations share this tax ID, including this one
Part of
Three Rivers Anesthsia

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1404950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406592000000",
    "number": "1669888681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "615-465-7000",
            "fax_number": "615-465-3007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N ONE MILE RD",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "638412539",
            "telephone_number": "573-624-3600",
            "fax_number": "573-624-4702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POPLAR BLUFF REGIONAL MEDICAL CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POPLAR BLUFF REGIONAL MEDICAL CENTER, LLC",
        "enumeration_date": "2014-07-10",
        "last_updated": "2014-07-29",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "SR. DIRECTOR",
        "authorized_official_telephone_number": "615-465-7587"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dexter Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dexter, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.