NPIMap

Individual provider Active NPI

Hannah Jo Braungardt, DO

  • Family Medicine Physician
  • Edina, MO
National Provider Identifier
1780200113
Registry record updated Jul 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2023025344 Issued in MO
Practice address
104 E Jackson St
Edina, MO 63537-1335
Phone
(660) 397-3517
Fax
(660) 397-2307
NPI assigned
Jun 22, 2020
Last updated
Jul 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2023

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 2023025344 MO Primary

Addresses

Primary practice location

104 E Jackson St
Edina, MO 63537-1335

Mailing address

104 E Jackson St
Edina, MO 63537-1335
Phone (660) 397-3517

Other names 1

  • Dr. Hannah Jo Braungardt Goodwin Other name

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
I20230817000643 MO Practitioner - Family Practice 0244653301 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Missouri Health Council IncGroup PAC ID 1658280805, shared by 9 NPIs, 20 clinicians

Practice addresses (Care Compare)

104 E Jackson St
Edina, MO 63537-1335
Phone (660) 397-3517

1506 Crown Dr
Kirksville, MO 63501-2553
Phone (660) 627-4493

52334 S Bus Hwy 5
Milan, MO 63556
Phone (660) 265-1042

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Missouri Health Council, Inc. Family Medicine CurrentSince Aug 1, 2023 Accepting new patients
Northeast Missouri Health Council Inc Family Medicine CurrentSince Sep 1, 2023 Accepting new patients
Northeast Missouri Health Council, Inc. CurrentSince Sep 1, 2023 Accepting new patients
Northeast Missouri Health Council Inc CurrentSince Aug 1, 2023 Accepting new patients
Northeast Missouri Health Council, Inc. Family Medicine Current Accepting new patients

Locations

104 E Jackson St
Edina, MO 63537
Phone (660) 397-3517

1416 Crown Dr
Kirksville, MO 63501
Phone (660) 627-4493

1506 Crown Dr
Kirksville, MO 63501
Phone (660) 627-4493

402 W Jefferson St
Kirksville, MO 63501
Phone (660) 665-2741

209 N Missouri St
Macon, MO 63552
Phone (660) 385-4999

118 E Grand Ave
Memphis, MO 63555
Phone (660) 465-7522

52334 Business Highway 5
Milan, MO 63556
Phone (660) 265-1042

Interoperability endpoints

  • Direct secure messaging: hannah.braungardt.p1@direct.nmhcinc.nextgenshare.com

Organizations & group practices 5

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 9

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": "1592784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1780200113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 E JACKSON ST",
            "city": "EDINA",
            "state": "MO",
            "postal_code": "635371335",
            "telephone_number": "660-397-3517",
            "fax_number": "660-397-2307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 E JACKSON ST",
            "city": "EDINA",
            "state": "MO",
            "postal_code": "635371335",
            "telephone_number": "660-397-3517",
            "fax_number": "660-397-2307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAUNGARDT",
        "first_name": "HANNAH",
        "middle_name": "JO",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-22",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2023025344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HANNAH",
            "last_name": "GOODWIN",
            "middle_name": "JO BRAUNGARDT",
            "prefix": "DR.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Edina, MO

Sources for this page

Verify at the official NPI Registry.