NPIMap

Individual provider Active NPI

Darwin L Davis Jr., M.D.

  • Family Medicine Physician
  • Poplar Bluff, MO
National Provider Identifier
1710942115
Registry record updated Feb 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
100921 Issued in MO
Practice address
2002 Kanell Blvd
Suite 103
Poplar Bluff, MO 63901-4045
Phone
(573) 727-9130
Fax
(573) 727-9128
NPI assigned
Apr 19, 2006
Last updated
Feb 28, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2012

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 100921 MO Primary

Addresses

Primary practice location

2002 Kanell Blvd
Suite 103
Poplar Bluff, MO 63901-4045

Mailing address

PO Box 989
Poplar Bluff, MO 63902-0989
Phone (573) 778-0020

Other identifiers 2

IdentifierTypeStateIssuer
596059709MedicaidMO
17094OtherMOBLUE CROSS BLUE SHIELD

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
I20050801000319 MO Practitioner - Family Practice 5294724225 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
100921MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Health Center of Stoddard County, LLC Family Medicine CurrentSince Jan 1, 2015 Accepting new patients
Southeast Health Center of Stoddard County LLC Family Medicine CurrentSince Jan 1, 2015 Accepting new patients
Southeast Health Center of Stoddard County, LLC Family Medicine Current Accepting new patients
Advanced Health Care Management Services, LLC PastSince Jul 7, 2003 Accepting new patients
Poplar Bluff Regional Medical Center LLC Past Accepting new patients
Advanced Healthcare Surgical Center, LLC PastSince May 6, 2003 Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients

Locations

1200 N One Mile Rd
Dexter, MO 63841
Phone (573) 614-1900

100 Highway 21 N
Ellington, MO 63638
Phone (573) 663-2511

2002 Kanell Blvd
Poplar Bluff, MO 63901
Phone (573) 727-9130

2002 Kanell Blvd
Ste 103
Poplar Bluff, MO 63901
Phone (573) 727-9130

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330387200000",
    "number": "1710942115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 989",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639020989",
            "telephone_number": "573-778-0020",
            "fax_number": "573-776-7548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 KANELL BLVD",
            "address_2": "SUITE 103",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639014045",
            "telephone_number": "573-727-9130",
            "fax_number": "573-727-9128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "DARWIN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2012-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "100921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "596059709",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "17094",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poplar Bluff, MO

Sources for this page

Verify at the official NPI Registry.