NPIMap

Individual provider Active NPI

Amie Lynn Etters, MD

  • Family Medicine Physician
  • Windsor, MO
National Provider Identifier
1750309514
Registry record updated Dec 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
110902 Issued in MO
Practice address
100 S Tebo St
Windsor, MO 65360-1161
Phone
(660) 647-2147
Fax
(660) 647-2160
NPI assigned
Jul 18, 2006
Last updated
Dec 17, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 110902 MO Primary

Addresses

Primary practice location

100 S Tebo St
Windsor, MO 65360-1161

Mailing address

100 S Tebo St
Windsor, MO 65360-1161
Phone (660) 647-2147

Other identifiers 3

IdentifierTypeStateIssuer
24313042OtherMOBLUE CROSS BLUE SHIELD KC
10871482OtherMOCAQH
2583144OtherMOAETNA

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
I20050916000327 MO Practitioner - Family Practice 2365475753 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Missouri, Kansas City, School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

100 S Tebo St
Windsor, MO 65360-1161
Phone (660) 647-2147

1600 N 2ND St
Clinton, MO 64735-1192
Phone (660) 885-5511

1602 N 2ND St
Clinton, MO 64735-1192

1771 Commercial St
Warsaw, MO 65355-3096
Phone (660) 438-5193

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
110902MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Golden Valley Memorial Hospital District Current Accepting new patients
Golden Valley Memorial Hospital District CurrentSince Dec 14, 2014 Accepting new patients
Golden Valley Memorial Hospital District CurrentSince Dec 14, 2014 Accepting new patients
Golden Valley Memorial Hospital District Past Accepting new patients
University Health Physicians Family Medicine Past Accepting new patients

Locations

1600 N 2nd St
Clinton, MO 64735
Phone (660) 885-8171

1602 N 2nd St
Clinton, MO 64735
Phone (660) 885-8171

100 S Tebo St
Windsor, MO 65360
Phone (660) 647-2134

Interoperability endpoints

  • Direct secure messaging: amieetters@mhccaremail.com

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418774400000",
    "number": "1750309514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S TEBO ST",
            "city": "WINDSOR",
            "state": "MO",
            "postal_code": "653601161",
            "telephone_number": "660-647-2147",
            "fax_number": "660-647-2160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S TEBO ST",
            "city": "WINDSOR",
            "state": "MO",
            "postal_code": "653601161",
            "telephone_number": "660-647-2147",
            "fax_number": "660-647-2160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTERS",
        "first_name": "AMIE",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2014-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "110902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD KC",
            "identifier": "24313042",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "10871482",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2583144",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Windsor, MO

Sources for this page

Verify at the official NPI Registry.