NPIMap

Individual provider Active NPI

Rafael Marroquin, M.D.

  • Diagnostic Radiology Physician
  • Columbia, MO
National Provider Identifier
1740419431
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2012020291 Issued in MO
Practice address
1600 E Broadway
Columbia, MO 65201-5844
Phone
(573) 815-3221
Fax
(573) 815-6343
NPI assigned
Jul 2, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X 2012020291 MO
Internal Medicine Physician 207R00000X 2012020291 MO
Diagnostic Radiology Physician 2085R0202X 2012020291 MO Primary

Addresses

Primary practice location

1600 E Broadway
Columbia, MO 65201-5844

Mailing address

1600 E Broadway
Columbia, MO 65201-5844
Phone (573) 815-3221

Other identifiers 1

IdentifierTypeStateIssuer
204255608MedicaidMO

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
I20121127000681 MO Practitioner - Diagnostic RadiologyPractitioner - Internal Medicine 3476704354 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Curators of the University of MissouriGroup PAC ID 4486759560, 1,108 clinicians
Boone Physician Services LLCGroup PAC ID 6507090644, 243 clinicians

Practice addresses (Care Compare)

1100 Virginia Ave
Columbia, MO 65212-0001
Phone (573) 882-2667

1600 E Broadway
Columbia, MO 65201-5844
Phone (573) 815-8000

Hospital & facility affiliations

  • Boone Hospital Center Hospital, Columbia, MO, CCN 260068
  • University of Missouri Health Care Hospital, Columbia, MO, CCN 260141
  • Macon County Samaritan Memorial Hospital Hospital, Macon, MO, CCN 261313
  • Fitzgibbon Hospital Hospital, Marshall, MO, CCN 260142
  • Northeast Regional Medical Center Hospital, Kirksville, MO, CCN 260022

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2012020291MOMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Curators of the University of Missouri CurrentSince Feb 21, 2022 Accepting new patients
Curators of the University of Missouri CurrentSince Feb 21, 2022 Accepting new patients
Landmark Hospital of Columbia LLC CurrentSince Nov 16, 2023 Accepting new patients
Boone Physician Services, LLC CurrentSince Nov 16, 2023 Accepting new patients

Locations

17651 Highway B
Boonville, MO 65233
Phone (660) 882-7461

604 Old Highway 63 N
Columbia, MO 65201
Phone (573) 499-6600

1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000

1 Hospital Dr
Columbia, MO 65212
Phone (573) 882-2568

1705 E Broadway
Ste 280
Columbia, MO 65201
Phone (573) 815-7119

1100 Virginia Ave
Columbia, MO 65212
Phone (573) 882-2663

3255 Independence St
Cpe Girardeau, MO 63701
Phone (573) 331-8026

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1246492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1740419431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 E BROADWAY",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652015844",
            "telephone_number": "573-815-3221",
            "fax_number": "573-815-6343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 E BROADWAY",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652015844",
            "telephone_number": "573-815-3221",
            "fax_number": "573-815-6343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARROQUIN",
        "first_name": "RAFAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-02",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "MO",
            "license": "2012020291",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2012020291",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2012020291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204255608",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.