NPIMap

Individual provider Active NPI

Anthony Anderson, MD

  • Family Medicine Physician
  • Festus, MO
National Provider Identifier
1679524094
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036119093 Issued in IL
Practice address
1479A U.S. Highway 61
Festus, MO 63028-4123
Phone
(636) 931-5533
Fax
(636) 931-5502
NPI assigned
May 12, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MDR7H67 MO
Anesthesiology Physician 207L00000X 036119093 IL
Family Medicine Physician 207Q00000X 036119093 IL Primary
Pain Medicine Physician 208VP0000X 036119093 IL
Interventional Pain Medicine Physician 208VP0014X 036119093 IL

Addresses

Primary practice location

1479A U.S. Highway 61
Festus, MO 63028-4123

Mailing address

1479A U.S. Highway 61
Festus, MO 63028-4123
Phone (636) 931-5533

Other identifiers 3

IdentifierTypeStateIssuer
200132704OtherMOCDS
205069909MedicaidMO
036119093MedicaidIL

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
I20070625000665 MO Practitioner - Pain ManagementPractitioner - AnesthesiologyPractitioner - Interventional Pain Management 7719922285 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Anesthesiology
Education
University of Missouri, Kansas City, School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1439 US Hwy 61 a
Festus, MO 63028

1439 US Hyw 61 a
Festus, MO 63028-4109

1479 US Hwy 61
Suite a
Festus, MO 63028-4162
Phone (636) 931-5533

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036119093ILMDAnesthesiology Physician
MDR7H67MOMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Id Consultants, P.C. PastSince Nov 5, 2012 Accepting new patients
Anesthesia Associates of Jefferson County Anesthesiology Past Accepting new patients
Acuity Anesthesiology LLC Anesthesiology Past Accepting new patients
Occupational & Pain Management Professionals PastSince Jan 1, 1990 Accepting new patients
Jefferson Memorial Surgical Partners LLC Past Accepting new patients
Fairview Heights Medical Group SC Past Accepting new patients
Occupational & Pain Management Professionals PastSince Jan 1, 1990 Accepting new patients
Ambulatory Anesthesia Services of Missouri LLC Anesthesiology PastSince Jul 1, 2008 Accepting new patients

Organizations & group practices 9

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 3

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1679524094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1479A U.S. HIGHWAY 61",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284123",
            "telephone_number": "636-931-5533",
            "fax_number": "636-931-5502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1479A U.S. HIGHWAY 61",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284123",
            "telephone_number": "636-931-5533",
            "fax_number": "636-931-5502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "ANTHONY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "MDR7H67",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036119093",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036119093",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "IL",
            "license": "036119093",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IL",
            "license": "036119093",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDS",
            "identifier": "200132704",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205069909",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036119093",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Festus, MO

Sources for this page

Verify at the official NPI Registry.