Active NPI
Wendell H Elliott, MD
- Family Medicine Physician
- Poplar Bluff, MO
National Provider Identifier
1730168592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R5G12
- Practice address
- 686 Lester St
Poplar Bluff, MO 63901-5025 - Phone
- (573) 686-2411
- Fax
- (573) 686-8452
- NPI assigned
- Jan 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R5G12 | MO | Primary |
Addresses
Primary practice location
686 Lester St
Poplar Bluff, MO 63901-5025
Mailing address
PO Box 220
Poplar Bluff, MO 63902-0220
Phone (573) 686-2411
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 113765001 | Medicaid | AR | |
| 080037682 | Other | TRAVELERS MEDICARE | |
| 20Z414900 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Poplar Bluff Regional Medical Center LLC | Past | Accepting new patients | |
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Ozarks Healthcare
- General Acute Care Hospital
- West Plains, MO
- NPI 1831115641
Family Medicine
-
dba Poplar Bluff Regional Medical Center
- General Acute Care Hospital
- Poplar Bluff, MO
- NPI 1700831724
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446681600000",
"number": "1730168592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 220",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639020220",
"telephone_number": "573-686-2411",
"fax_number": "573-686-8452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "686 LESTER ST",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639015025",
"telephone_number": "573-686-2411",
"fax_number": "573-686-8452"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "WENDELL",
"middle_name": "H",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-11",
"last_updated": "2015-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "R5G12",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "113765001",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRAVELERS MEDICARE",
"identifier": "080037682",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "20Z414900",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.