John Derick Paulson, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5883 Issued in OK

Practice address

530 S Maiden LN
Joplin, MO 64801-3084

Phone

(417) 782-6200

NPI assigned

Nov 19, 2007

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Freeman Neosho Hospital

  • Internal Medicine Physician
  • Neosho, MO
  • NPI 1083045686

  Family Medicine, MO

  Medicare reassignment NPD
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Anderson, MO
  • NPI 1265428791

  MO

  Medicare reassignment NPD
• Freeman Neosho Hospital

  • Rural Health Clinic/Center
  • Anderson, MO
  • NPI 1437513686
  NPD
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Joplin, MO
  • NPI 1649837444
  NPD
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Joplin, MO
  • NPI 1538151733
  NPD (past)
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Carthage, MO
  • NPI 1992995120
  NPD (past)
• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641

  Family Medicine

  NPD (past)
• Texas County Memorial Hospital

  • Rural Health Clinic/Center
  • Licking, MO
  • NPI 1447412770
  NPD (past)
• Texas County Memorial Hospital

  • Rural Health Clinic/Center
  • Houston, MO
  • NPI 1710004486
  NPD (past)

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Ozark Tri County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Joplin, MO
  • NPI 1376582346

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Diamond, MO
  • NPI 1003573015

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Neosho, MO
  • NPI 1013368984

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Pineville, MO
  • NPI 1063178341

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Neosho, MO
  • NPI 1114626652

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Neosho, MO
  • NPI 1134828676

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Neosho, MO
  • NPI 1134828692

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Pineville, MO
  • NPI 1134886005

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Cassville, MO
  • NPI 1205886769

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Joplin, MO
  • NPI 1215696976

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Anderson, MO
  • NPI 1265428791

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Joplin, MO
  • NPI 1295908911

  Corporate Officer, W-2 Managing Employee

  CMS ownership

Specialty

Family Practice

Education

Oklahoma State University College of Osteopathic Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ozark Tri-County Health Care Consortium 38 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: john.paulson@othcdafc.eclinicaldirectplus.com

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 4, 2020.

{
    "created_epoch": "1195430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591228800000",
    "number": "1801077797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 S YALE AVE",
            "address_2": "SUITE 1400",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363347",
            "telephone_number": "918-488-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 S MAIDEN LN",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648013084",
            "telephone_number": "417-782-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULSON",
        "first_name": "JOHN",
        "middle_name": "DERICK",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-19",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "5883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26D0679044",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RH MEDICAID",
            "identifier": "597780303",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00849708",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801077797",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RH MEDICARE",
            "identifier": "26-8535",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235178930",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447412770",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26D0889777",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jon Patrick Patterson, DO
• Michael John Patterson, DDS
• Reese E Patterson
• Ryan Joseph Patterson, DO
• Samantha Patterson, LMT
• Amber L Payne
• Tylor Scott Payne, CAA
• Jami Elane Payton, FNP-C
• Pediatric Associates of Southwest Missouri, LLC
• Laura Helene Pellizzari, DPM

• All providers in Joplin, MO
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.