Individual provider Active NPI

Paul Kolm, DO

  • Emergency Medicine Physician
  • Fulton, MO
National Provider Identifier
1801956008
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2003009747 Issued in MO
Practice address
10 S Hospital Dr
Fulton, MO 65251-2510
Phone
(573) 592-6550
NPI assigned
Dec 11, 2006
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
Emergency Medicine Physician 207P00000X 2003009747 MO Primary

Addresses

Primary practice location

10 S Hospital Dr
Fulton, MO 65251-2510

Mailing address

861 SW 78TH Ave
Suite # 100B
Plantation, FL 33324-3273
Phone (954) 693-0000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2003009747MOMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carthage Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Poplar Bluff Regional Medical Center Past Accepting new patients
Poplar Bluff Regional Medical Center LLC Past Accepting new patients
Twin Rivers Emergency Physicians, LLC Emergency Medicine Past Accepting new patients
Poplar Bluff Regional Medical Center, Inc Past Accepting new patients
Dexter Emergency Physicians, LLC Emergency Medicine Past Accepting new patients
Callaway Emergency Physicians, LLC Emergency Medicine Past Accepting new patients

Organizations & group practices 7

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801956008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "861 SW 78TH AVE",
            "address_2": "SUITE # 100B",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333243273",
            "telephone_number": "954-693-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 S HOSPITAL DR",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652512510",
            "telephone_number": "573-592-6550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLM",
        "first_name": "PAUL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2003009747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fulton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.