Individual provider Active NPI

Richard E Daugherty, M.D.

  • Family Medicine Physician
  • Jefferson City, MO
National Provider Identifier
1760426878
Registry record updated Dec 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD115048 Issued in MO
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, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2011

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 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

IdentifierTypeStateIssuer
203825906MedicaidMO

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040907000828 MO Practitioner - Family Practice 4688640105 Reassigns benefits to 1 organization

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

LicenseStateTypeSpecialty
MD115048MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Ctr of Central Missouri Family Medicine CurrentSince Dec 26, 2011 Accepting new patients
Community Health Ctr of Central Missouri Family Medicine Current Accepting new patients
Community Health Ctr of Central Missouri Family Medicine CurrentSince Dec 26, 2011 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

  • Direct secure messaging: 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.

Hospital & facility affiliations 3

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": "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

Verify at the official NPI Registry.