NPIMap

Individual provider Active NPI

Mandi Nicole Parks

  • Family Nurse Practitioner
  • Salem, MO
National Provider Identifier
1760966188
Registry record updated Oct 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2018036147 Issued in MO
Practice address
35629 Highway 72
Salem, MO 65560-7217
Phone
(573) 729-8000
NPI assigned
Sep 21, 2018
Last updated
Oct 3, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2018036147 MO Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

35629 Highway 72
Salem, MO 65560-7217

Mailing address

PO Box 213
Salem, MO 65560-0213

Other practice location 1

18950 Highway C
Lenox, MO 65541-9306
Phone (573) 247-0715

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
I20181127001566 MO Practitioner - Nurse Practitioner 9638413925 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

703 S Grand Ave
Salem, MO 65560-2132
Phone (573) 426-4455

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Central Missouri Community Health Center Current Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1050 W 10th St
Ste 480
Rolla, MO 65401
Phone (573) 364-1900

1081 E 18th St
Rolla, MO 65401
Phone (573) 426-2407

165 Park Dr
Saint Robert, MO 65584
Phone (573) 433-3559

601 S McArthur St
Salem, MO 65560
Phone (573) 426-2407

Organizations & group practices 2

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 7

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": "1537488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538524800000",
    "number": "1760966188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 213",
            "city": "SALEM",
            "state": "MO",
            "postal_code": "655600213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35629 HIGHWAY 72",
            "city": "SALEM",
            "state": "MO",
            "postal_code": "655607217",
            "telephone_number": "573-729-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18950 Highway C",
            "address_purpose": "LOCATION",
            "city": "Lenox",
            "state": "MO",
            "postal_code": "655419306",
            "country_code": "US",
            "telephone_number": "573-247-0715",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARKS",
        "first_name": "MANDI",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-21",
        "last_updated": "2018-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2018036147",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, MO

Sources for this page

Verify at the official NPI Registry.