NPIMap

Organization Active NPI

Mercy Clinic Joplin, LLC

Doing business as Mercy Clinic-Oswego-Family Medicine

  • Rural Health Clinic/Center
  • Oswego, KS
National Provider Identifier
1740517341
Registry record updated Jun 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY CLINIC JOPLIN, LLC
Doing business as
Mercy Clinic-Oswego-Family Medicine
Practice address
805 Barker Dr
Oswego, KS 67356
Phone
(620) 795-2525
NPI assigned
Nov 3, 2009
Last updated
Jun 11, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2018

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

Authorized official

Name
Tracy A Godfrey, MD
Title
President
Phone
(417) 556-8962

Specialties & licenses 1

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

Addresses

Primary practice location

805 Barker Dr
Oswego, KS 67356

Mailing address

645 Maryville Centre Dr FL 3
Saint Louis, MO 63141-5855
Phone (417) 820-7133

Other identifiers 5

IdentifierTypeStateIssuer
1740517341OtherKSKANSAS BLUE CROSS
615149202OtherKSDEPARTMENT OF LABOR (OWCP-DEEOIC)
200274980EMedicaidOK
1740517341MedicaidMO
200639810FMedicaidKS

Other names 1

  • Mercy Clinic-Oswego-Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091214000066 KS Part B Supplier - Clinic/Group Practice 0547300196 Receives reassigned benefits from 75 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pittsburg, KS; Oswego, KS; Galena, KS; Fort Scott, KS; Columbus, KS

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

805 Barker Dr
Oswego, KS 67356
Phone (620) 795-2525

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1257206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528675200000",
    "number": "1740517341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 MARYVILLE CENTRE DR FL 3",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415855",
            "telephone_number": "417-820-7133",
            "fax_number": "417-820-0586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 BARKER DR",
            "city": "OSWEGO",
            "state": "KS",
            "postal_code": "67356",
            "telephone_number": "620-795-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY CLINIC JOPLIN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-03",
        "last_updated": "2018-06-11",
        "status": "A",
        "authorized_official_last_name": "GODFREY",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "417-556-8962",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KANSAS BLUE CROSS",
            "identifier": "1740517341",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR (OWCP-DEEOIC)",
            "identifier": "615149202",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200274980E",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740517341",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200639810F",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Clinic-Oswego-Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Clinic-Oswego-Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oswego, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.