Active NPI
Jerry Neil Spurgeon, LMSW
- Clinical Social Worker
- Hannibal, MO
National Provider Identifier
1740639202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2015031751
- Practice address
- 917 Broadway
Hannibal, MO 63401-4200 - Phone
- (573) 221-2120
- Fax
- (573) 221-4380
- NPI assigned
- Jun 6, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2015031751 | MO | Primary |
Addresses
Primary practice location
917 Broadway
Hannibal, MO 63401-4200
Mailing address
917 Broadway
Hannibal, MO 63401-4200
Phone (573) 221-2120
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2015031751 | MO | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465776000000",
"number": "1740639202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "917 BROADWAY",
"city": "HANNIBAL",
"state": "MO",
"postal_code": "634014200",
"telephone_number": "573-221-2120",
"fax_number": "573-221-4380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "917 BROADWAY",
"city": "HANNIBAL",
"state": "MO",
"postal_code": "634014200",
"telephone_number": "573-221-2120",
"fax_number": "573-221-4380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPURGEON",
"first_name": "JERRY",
"middle_name": "NEIL",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-06-06",
"last_updated": "2016-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "2015031751",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hannibal, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.