NPIMap

Organization Active NPI

Mercy Clinic-Springfield Communities

Doing business as Mercy Clinic Family Medicine - Rolla

  • Rural Health Clinic/Center
  • Rolla, MO
National Provider Identifier
1811028723
Registry record updated Dec 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY CLINIC-SPRINGFIELD COMMUNITIES
Doing business as
Mercy Clinic Family Medicine - Rolla
Practice address
1605 Martin Springs Dr Ste 210
Rolla, MO 65401-3028
Phone
(573) 458-6350
Fax
(573) 458-6764
NPI assigned
Mar 9, 2007
Last updated
Dec 4, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2018

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

Authorized official

Name
Dr. Robert Cavagnol
Title
Chief Physician Officer
Phone
(417) 820-2705

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X MO Primary
Family Nurse Practitioner 363LF0000X 064070 MO
Family Medicine Physician 207Q00000X R5474 MO

Addresses

Primary practice location

1605 Martin Springs Dr Ste 210
Rolla, MO 65401-3028

Mailing address

645 Maryville Centre Dr FL 3
Saint Louis, MO 63141-5855
Phone (417) 820-7133

Other identifiers 1

IdentifierTypeStateIssuer
595684804MedicaidMO

Other names 1

  • Mercy Clinic Family Medicine - Rolla Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031218000354 MO Part B Supplier - Clinic/Group Practice 7416865845 Receives reassigned benefits from 1,639 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 29

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 29

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0446860Mercy Clinic Family Medicine-Rolla1605 Martin Springs Drive Ste 210 230, Rolla, MO 65401Certificate of waiverOct 31, 2026

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543881600000",
    "number": "1811028723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 MARYVILLE CENTRE DR FL 3",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415855",
            "telephone_number": "417-820-7133",
            "fax_number": "417-820-0586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 MARTIN SPRINGS DR STE 210",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654013028",
            "telephone_number": "573-458-6350",
            "fax_number": "573-458-6764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY CLINIC-SPRINGFIELD COMMUNITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2018-12-04",
        "status": "A",
        "authorized_official_last_name": "CAVAGNOL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF PHYSICIAN OFFICER",
        "authorized_official_telephone_number": "417-820-2705",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "064070",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R5474",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "595684804",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Clinic Family Medicine - Rolla",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rolla, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.