Active NPI
Richard E Daugherty, M.D.
- Family Medicine Physician
- Jefferson City, MO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD115048
- Practice address
- 3400 W Truman Blvd
Jefferson City, MO 65109-5712 - Phone
- (573) 632-2777
- Fax
- (573) 632-2769
- NPI assigned
- Jun 16, 2006
- Last updated
- Dec 29, 2011
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD115048 | MO | Primary |
Addresses
Primary practice location
3400 W Truman Blvd
Jefferson City, MO 65109-5712
Mailing address
PO Box 104780
Jefferson City, MO 65110-4780
Phone (573) 632-0243
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 203825906 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Wright State University Boonshoft School of Medicine, 1995
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
1511 Christy Dr
Jefferson City, MO 65101-2854
Phone (573) 632-2777
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD115048 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health Ctr of Central Missouri | Family Medicine | Current | Accepting new patients |
| Community Health Ctr of Central Missouri | Family Medicine | Current | Accepting new patients |
| Community Health Ctr of Central Missouri | Family Medicine | Current | Accepting new patients |
| SSM Regional Health Servcies | Past | Accepting new patients |
Locations
1511 Christy Dr
Jefferson Cty, MO 65101
Phone (573) 606-6924
3400 W Truman Blvd
Jefferson Cty, MO 65109
Phone (573) 636-2181
Interoperability endpoints
- rick.daugherty.p1@direct.chccmo.nextgenshare.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Federally Qualified Health Center (FQHC)
- Linn, MO
- NPI 1538213244
Family Medicine
-
- Federally Qualified Health Center (FQHC)
- Jefferson City, MO
- NPI 1427225275
Family Medicine
-
dba Community Health Center of Central Missouri-Christy Drive
- Federally Qualified Health Center (FQHC)
- Jefferson City, MO
- NPI 1972001386
Family Medicine
-
dba St. Marys Urgent Care at the Lake
- Urgent Care Clinic/Center
- Lake Ozark, MO
- NPI 1316993256
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Capital Region Medical Center
- General Acute Care Hospital
- Jefferson City, MO
- NPI 1174597892
-
dba University of Missouri Health Care
- General Acute Care Hospital
- Columbia, MO
- NPI 1699769901
-
dba SSM Health St. Mary's Hospital Jefferson City
- General Acute Care Hospital
- Jefferson City, MO
- NPI 1518065523
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325116800000",
"number": "1760426878",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 104780",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651104780",
"telephone_number": "573-632-0243",
"fax_number": "573-632-6900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 W TRUMAN BLVD",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651095712",
"telephone_number": "573-632-2777",
"fax_number": "573-632-2769"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAUGHERTY",
"first_name": "RICHARD",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-16",
"last_updated": "2011-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "MD115048",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "203825906",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Jefferson City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.