NPIMap

Individual provider Active NPI

Craig L Pendergrass, DO

  • Family Medicine Physician
  • Neosho, MO
National Provider Identifier
1700835469
Registry record updated Aug 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
110888 Issued in MO
Practice address
117 E Hickory St
Neosho, MO 64850-1806
Phone
(417) 451-4545
Fax
(417) 451-4546
NPI assigned
May 9, 2006
Last updated
Aug 17, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 110888 MO Primary

Addresses

Primary practice location

117 E Hickory St
Neosho, MO 64850-1806

Mailing address

PO Box 220
Neosho, MO 64850-0220
Phone (417) 451-4545

Other identifiers 5

IdentifierTypeStateIssuer
P00248178OtherRR MEDICARE
110571OtherMOANTHEM
248916405MedicaidMO
100296690CMedicaidKS
100183590AMedicaidOK

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
I20050808000189 MO Practitioner - Family Practice 9537159801 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
R Franklin University of Med & Sci/Chicago Medical School, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sgoh Acquisition IncGroup PAC ID 5092616276, 95 clinicians

Practice addresses (Care Compare)

125 Main St
Noel, MO 64854-9124
Phone (417) 475-6151

1355 Rocketdyne Rd
Neosho, MO 64850-3106
Phone (417) 451-7425

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
110888MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sgoh Acquisition Inc CurrentSince Jan 1, 2023 Accepting new patients
Sgoh Acquisition Inc CurrentSince Jan 1, 2023 Accepting new patients
Sgoh Acquisition Inc Past Accepting new patients
Freeman Neosho Hospital Past Accepting new patients

Locations

1101 Jackson St SW
Gravette, AR 72736
Phone (479) 787-5221

106 S Hickory St
Mount Vernon, MO 65712
Phone (417) 466-4110

117 E Hickory St
Neosho, MO 64850
Phone (417) 451-4545

1355 Rocketdyne Rd
Neosho, MO 64850
Phone (417) 451-2240

Interoperability endpoints

  • Direct secure messaging: craig.pendergrass.1@32068.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Freeman Neosho HospitalNeosho, MO, CCN 261331 Hospital Corporate Director Oct 5, 2005
Freeman Neosho HospitalNeosho, MO, CCN 26Z331 Hospital Corporate Director Oct 5, 2005
GentivaJoplin, MO, CCN 261585 Hospice Contracted Managing Employee May 20, 2009
Freeman Clinic of AndersonAnderson, MO, CCN 268773 Rural health clinic Corporate Director May 7, 2025

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 11

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": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692230400000",
    "number": "1700835469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648500220",
            "telephone_number": "417-451-4545",
            "fax_number": "417-451-4546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 E HICKORY ST",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648501806",
            "telephone_number": "417-451-4545",
            "fax_number": "417-451-4546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDERGRASS",
        "first_name": "CRAIG",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-09",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "110888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00248178",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "110571",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "248916405",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100296690C",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100183590A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Neosho, MO

Sources for this page

Verify at the official NPI Registry.