NPIMap

Individual provider Active NPI

Michael Scott Severance, MD

  • Urology Physician
  • Jefferson City, MO
National Provider Identifier
1790708907
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
101963 Issued in MO
Practice address
3207 W Truman Blvd
Jefferson City, MO 65109-0578
Phone
(573) 636-5115
Fax
(573) 636-2818
NPI assigned
Jul 26, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 101963 MO Primary

Addresses

Primary practice location

3207 W Truman Blvd
Jefferson City, MO 65109-0578

Mailing address

3207 W Truman Blvd
Jefferson City, MO 65109-0578
Phone (573) 636-5115

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
I20100820000479 MO Practitioner - Urology 3678539707 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Albany Medical College of Union University, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Regional Health SystemGroup PAC ID 9133026776, 132 clinicians

Practice addresses (Care Compare)

1075 Nichols Rd
Osage Beach, MO 65065-3093
Phone (573) 302-3990

54 Hospital Dr
Osage Beach, MO 65065-3050

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.58 of 100Reported as group
Promoting interoperability
100
Improvement activities
40
Cost
65.27

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
101963MOMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Regional Health System CurrentSince Apr 1, 2025 Accepting new patients
Lake Regional Health System CurrentSince Apr 1, 2025 Accepting new patients
Lake Regional Medical Management, Inc. CurrentSince Sep 1, 2023 Accepting new patients
Urology Care, Inc. Urology CurrentSince Aug 1, 1994 Accepting new patients
Lake Regional Health System Past Accepting new patients

Locations

3207 W Truman Blvd
Jefferson Cty, MO 65109
Phone (573) 636-5115

3207 W Truman Blvd
Ste A
Jefferson Cty, MO 65109
Phone (573) 298-6855

1029 Nichols Rd
Ste 401
Osage Beach, MO 65065
Phone (573) 302-3111

54 Hospital Dr
Osage Beach, MO 65065
Phone (573) 280-2772

Interoperability endpoints

  • Direct secure messaging: michaelseverance@mhccaremail.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 6

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": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790708907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3207 W TRUMAN BLVD",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651090578",
            "telephone_number": "573-636-5115",
            "fax_number": "573-636-2818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3207 W TRUMAN BLVD",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651090578",
            "telephone_number": "573-636-5115",
            "fax_number": "573-636-2818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEVERANCE",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MO",
            "license": "101963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson City, MO

Sources for this page

Verify at the official NPI Registry.