NPIMap

Organization Active NPI

Big Tree Medical Group LLC

Doing business as Big Tree Medical Home

  • Family Medicine Physician
  • Columbia, MO
National Provider Identifier
1740858562
Registry record updated Jan 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BIG TREE MEDICAL GROUP LLC
Doing business as
Big Tree Medical Home
Practice address
200 Corporate Lake Dr
Columbia, MO 65203-7172
Phone
(573) 814-1170
NPI assigned
Jun 17, 2021
Last updated
Jan 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2023

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

Authorized official

Name
Adam Wheeler, MDNPI 1891803086
Title
Ceo
Phone
(573) 673-5770

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X NU
Family Medicine Physician 207Q00000X NU Primary
Behavior Analyst 103K00000X NU
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

200 Corporate Lake Dr
Columbia, MO 65203-7172

Mailing address

200 Corporate Lake Dr
Columbia, MO 65203-7172
Phone (573) 814-1170

Other names 1

  • Big Tree Medical Home Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221017002513 MO Part B Supplier - Clinic/Group Practice 6507232543 Receives reassigned benefits from 12 practitioners
Practice locations: Columbia, MO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1623888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672790400000",
    "number": "1740858562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE LAKE DR",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652037172",
            "telephone_number": "573-814-1170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CORPORATE LAKE DR",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652037172",
            "telephone_number": "573-814-1170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIG TREE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-17",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A",
        "authorized_official_last_name": "WHEELER",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-673-5770",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Big Tree Medical Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Big Tree Medical Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; 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.