John L Abraham, M.D.
Individual provider Active NPI Family Medicine Physician · Springfield, MO
NPI 1760595136 · NPPES record last updated Jan 13, 2020
Key facts
- NPI
- 1760595136
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD115778 (MO)
- Practice address
- 2740 N Mayfair Ave
Springfield, MO 65803-5084 - Phone
- (417) 521-3925
- Fax
- (417) 521-6860
- NPI assigned
- Aug 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Missouri, Kansas City, School of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Lifestylerx Florida PA
Practice addresses (Care Compare)
107 W 9TH St
FL 2
Kansas City, MO 64105-1705
Phone (778) 653-2427
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050418000093 | MO | Practitioner - Family Practice |
0345287702 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD115778 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifestylerx California PC | Family Medicine | Current |
Accepting new patients |
| Lifestylerx Florida, P.a. | Family Medicine | Current |
Accepting new patients |
| Trinity Healthcare PC | Family Medicine | Current |
Accepting new patients |
| University Health Physicians | Family Medicine | Past | Accepting new patients |
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
Locations
20 University Rd
Ste 5
Cambridge, MA 02138
107 W 9th St
Fl 2
Kansas City, MO 64105
Phone (505) 382-2776
2740 N Mayfair Ave
Springfield, MO 65803
Phone (417) 521-3925
Interoperability endpoints
- john.abraham.1@21731.direct.athenahealth.com
- https://fhir.meditouchehr.com/api/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD115778 | MO | Yes |
Addresses
Primary practice location
2740 N Mayfair Ave
Springfield, MO 65803-5084
Mailing address
2740 N Mayfair Ave
Springfield, MO 65803-5084
Phone (417) 521-3925
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200374490A | Medicaid | KS | |
| 243419306 | Medicaid | MO | |
| 200079890A | Medicaid | OK |
Other providers in Springfield, MO
- Abilities First
- Ability Transportation, Inc
- Abl Healthcare Services, LLC
- Able Pathways LLC
- Bonnie Abraham
- Bailey Abram
- Melissa A Abramovitz
- Lisa M Abu-Bakr
- Abundance Quality Home Healthcare
- Laith Abushanab
All providers in Springfield, MO · Family Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.