NPIMap

Organization Active NPI

McPherson Medical & Diagnostic, LLC

Doing business as McPherson Medical and Diagnostic, LLC

  • Family Medicine Physician
  • Kennett, MO
National Provider Identifier
1679706956
Registry record updated Jun 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MCPHERSON MEDICAL & DIAGNOSTIC, LLC
Doing business as
McPherson Medical and Diagnostic, LLC
Practice address
901 W Commercial St
Kennett, MO 63857-1100
Phone
(573) 717-1072
Fax
(573) 717-1529
NPI assigned
Sep 2, 2009
Last updated
Jun 12, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MCPHERSON MEDICAL & DIAGNOSTIC, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 12, 2023

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

Authorized official

Name
Dr. Timothy W McPherson, DONPI 1245264696
Title
Owner
Phone
(573) 695-2181

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

901 W Commercial St
Kennett, MO 63857-1100

Mailing address

PO Box 12545
Belfast, ME 04915-4016
Phone (573) 717-1072

Other names 1

  • McPherson Medical and Diagnostic, LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061201000167 MO Part B Supplier - Clinic/Group Practice 5698773539 Receives reassigned benefits from 116 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kennett, MO; Macon, MO; Malden, MO; Saint Louis, MO; Saint Peters, MO; Scott City, MO; Steele, MO; Moberly, MO…

Other NPIs on the same Medicare enrollment 23

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

View all 23

National Provider Directory

National Provider Directory
Part of
American Medical Missouri

Locations

901 W Commercial St
Kennett, MO 63857
Phone (573) 695-2181

216 W Main St
Ste B
Steele, MO 63877
Phone (573) 695-2181

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": "1251849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1679706956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12545",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154016",
            "telephone_number": "573-717-1072",
            "fax_number": "573-717-1529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W COMMERCIAL ST",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638571100",
            "telephone_number": "573-717-1072",
            "fax_number": "573-717-1529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCPHERSON MEDICAL & DIAGNOSTIC, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCPHERSON MEDICAL & DIAGNOSTIC, LLC",
        "enumeration_date": "2009-09-02",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A",
        "authorized_official_last_name": "MCPHERSON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-695-2181",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McPherson Medical and Diagnostic, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "McPherson Medical and Diagnostic, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kennett, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.