Diamond Medical Care LLC
Organization Active NPI Primary Care Clinic/Center · Grain Valley, MO
NPI 1770978413 · NPPES record last updated Mar 31, 2015
Key facts
- NPI
- 1770978413
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- R9G82 (MO)
- Legal business name
- DIAMOND MEDICAL CARE LLC
- Practice address
- 1101 NW Pamela Blvd
Suite a
Grain Valley, MO 64029-7841 - Phone
- (816) 295-1606
- NPI assigned
- Mar 31, 2015
- Organization subpart
- No
Authorized official
- Name
- Dr. Brad Mouse, D.O.
- Title
- Physician
- Phone
- (816) 295-1606
Practitioners 1
-
Brad A. Mouse, DO
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150731014643 | MO | Part B Supplier - Clinic/Group Practice | 9739493081 |
Receives reassigned benefits from 1 practitioner Practice locations: Grain Valley, MO |
National Provider Directory
Locations
1101 NW Pamela Blvd
Ste A
Grain Valley, MO 64029
Phone (816) 295-1606
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | R9G82 | MO | Yes |
Addresses
Primary practice location
1101 NW Pamela Blvd
Suite a
Grain Valley, MO 64029-7841
Mailing address
1101 NW Pamela Blvd
Suite a
Grain Valley, MO 64029-7841
Phone (816) 295-1606
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588604979 | Medicaid | MO |
Other providers in Grain Valley, MO
- Randall Lee Culbertson
- Cwo Enterprises
- Caton Day
- Jenny De Marziani
- Kelly Jean Desselle
- Kayla Dominguez
- Kennedi Douglas
- Catherine Dowd
- Kaitlin Doyle
- Jennifer Sue Edwards
All providers in Grain Valley, MO · Primary Care Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2015. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.