NPIMap

Organization Active NPI

Bridges Medical Services P.C.

  • Rural Health Clinic/Center
  • Forsyth, MO
National Provider Identifier
1700902244
Registry record updated May 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BRIDGES MEDICAL SERVICES P.C.
Practice address
256 State Highway Y
Forsyth, MO 65653-5618
Phone
(417) 546-4200
Fax
(417) 546-4505
NPI assigned
Mar 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2014

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

Authorized official

Name
Janiece Rachelle Bridges, M.D.NPI 1184758617
Title
Medical Director
Phone
(417) 546-4200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

256 State Highway Y
Forsyth, MO 65653-5618

Mailing address

PO Box 1240
Forsyth, MO 65653-1240
Phone (417) 546-4200

Other identifiers 1

IdentifierTypeStateIssuer
595903402MedicaidMO

Other names 1

  • Bridges Medical Services - Forsyth Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030224000044 MO Part A Provider - Rural Health Clinic 9638088172 Practice locations: Forsyth, MO
O20110628000524 MO Part B Supplier - Clinic/Group Practice 9638088172 Receives reassigned benefits from 2 practitioners
2 other NPIs on this enrollment
Practice locations: Branson, MO; Forsyth, MO

Rural health clinic certification: CCN 263925

Legal name
BRIDGES MEDICAL SERVICES PC
Doing business as
N/A
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 3, 2002
Last certification
Jul 10, 2019
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Apr 1, 1999 in MO
Enrollment address
256 State Hwy Y
Forsyth, MO 65653-5564

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Bridges Medical Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

256 State Highway Y
Forsyth, MO 65653
Phone (417) 546-4200

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Leonard Bridges Individual 5% Or Greater Direct Ownership Interest Apr 1, 1999 50%
W-2 Managing EmployeeBoard Member, President Apr 1, 1999 50%
Janiece R Bridges Individual 5% Or Greater Direct Ownership Interest Apr 1, 1999 50%
W-2 Managing EmployeeMedical Director, Board Member Apr 1, 1999 50%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399852800000",
    "number": "1700902244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1240",
            "city": "FORSYTH",
            "state": "MO",
            "postal_code": "656531240",
            "telephone_number": "417-546-4200",
            "fax_number": "417-546-4505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "256 STATE HIGHWAY Y",
            "city": "FORSYTH",
            "state": "MO",
            "postal_code": "656535618",
            "telephone_number": "417-546-4200",
            "fax_number": "417-546-4505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGES MEDICAL SERVICES P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2014-05-12",
        "status": "A",
        "authorized_official_last_name": "BRIDGES",
        "authorized_official_first_name": "JANIECE",
        "authorized_official_middle_name": "RACHELLE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "417-546-4200",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "595903402",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridges Medical Services - Forsyth",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Forsyth, MO

Sources for this page

Verify at the official NPI Registry.