NPIMap

Organization Active NPI

Poplar Bluff Regional Medical Center, LLC

Doing business as Poplar Bluff Medical Clinic

  • Family Medicine Physician
  • Poplar Bluff, MO
National Provider Identifier
1760898787
Registry record updated Jul 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
POPLAR BLUFF REGIONAL MEDICAL CENTER, LLC
Doing business as
Poplar Bluff Medical Clinic
Practice address
2588 N Westwood Blvd
Poplar Bluff, MO 63901-2339
Phone
(573) 778-1277
Fax
(573) 778-1299
NPI assigned
Jul 10, 2014
Last updated
Jul 29, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
POPLAR BLUFF REGIONAL MEDICAL CENTER, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 29, 2014

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

Authorized official

Name
James P Wright
Title
Sr.Director
Phone
(615) 465-7587

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

2588 N Westwood Blvd
Poplar Bluff, MO 63901-2339

Mailing address

PO Box 689022
Franklin, TN 37068-9022
Phone (615) 465-7000

Other names 1

  • Poplar Bluff Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090911000300 MO Part B Supplier - Clinic/Group Practice 6800707225 Receives reassigned benefits from 14 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Poplar Bluff, MO; Dexter, MO; Malden, MO; Bloomfield, MO

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Poplar Bluff Regional Medical Center Inc11 organizations share this tax ID, including this one
Part of
Poplar Bluff Regional Medical Center Inc

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1404950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406592000000",
    "number": "1760898787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "615-465-7000",
            "fax_number": "615-465-3007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2588 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012339",
            "telephone_number": "573-778-1277",
            "fax_number": "573-778-1299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POPLAR BLUFF REGIONAL MEDICAL CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POPLAR BLUFF REGIONAL MEDICAL CENTER, LLC",
        "enumeration_date": "2014-07-10",
        "last_updated": "2014-07-29",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "SR.DIRECTOR",
        "authorized_official_telephone_number": "615-465-7587"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poplar Bluff Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2014; 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.