Active NPI
Michael J Wurm, MD
- Family Medicine Physician
- Maryville, MO
National Provider Identifier
1679578884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R5C38
- Practice address
- 2016 S Main St
Maryville, MO 64468-2659 - Phone
- (660) 562-2525
- Fax
- (660) 562-4050
- NPI assigned
- Jun 15, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R5C38 | MO | Primary |
Addresses
Primary practice location
2016 S Main St
Maryville, MO 64468-2659
Mailing address
114 E South Hills Dr
Maryville, MO 64468-2659
Phone (660) 562-2525
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0991968 | Medicaid | IA | |
| 201722303 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352419200000",
"number": "1679578884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 E SOUTH HILLS DR",
"city": "MARYVILLE",
"state": "MO",
"postal_code": "644682659",
"telephone_number": "660-562-2525",
"fax_number": "660-562-4303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2016 S MAIN ST",
"city": "MARYVILLE",
"state": "MO",
"postal_code": "644682659",
"telephone_number": "660-562-2525",
"fax_number": "660-562-4050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WURM",
"first_name": "MICHAEL",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-15",
"last_updated": "2012-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "R5C38",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0991968",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201722303",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maryville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.