NPIMap

Organization Active NPI

Poplar Bluff Regional Medical Center, LLC

  • Family Medicine Physician
  • Piedmont, MO
National Provider Identifier
1679989693
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
Practice address
1 Hals PLZ
Piedmont, MO 63957-1613
Phone
(573) 223-4800
Fax
(573) 223-7161
NPI assigned
Jul 10, 2014
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 PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1 Hals PLZ
Piedmont, MO 63957-1613

Mailing address

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

Other names 1

  • Piedmont Family 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.

National Provider Directory

National Provider Directory
Part of
Poplar Bluff Regional Medical Center

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": "1679989693",
    "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": "1 HALS PLZ",
            "city": "PIEDMONT",
            "state": "MO",
            "postal_code": "639571613",
            "telephone_number": "573-223-4800",
            "fax_number": "573-223-7161"
        }
    ],
    "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Piedmont Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Piedmont, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.