Individual provider Active NPI

Candise D Kroutil, MD

  • Family Medicine Physician
  • Springfield, MO
National Provider Identifier
1811930738
Registry record updated Dec 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
105768 Issued in MO
Practice address
1001 E Primrose St
Springfield, MO 65807-5155
Phone
(417) 875-3000
Fax
(417) 875-3383
NPI assigned
Jun 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2018

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 105768 MO Primary

Addresses

Primary practice location

1001 E Primrose St
Springfield, MO 65807-5155

Mailing address

PO Box 9007
Springfield, MO 65808-9007

Other identifiers 3

IdentifierTypeStateIssuer
107910OtherBLUE CROSS/BLUE SHIELD
208688325MedicaidMO
208688317MedicaidMO

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200420000312 MO Order and Referring Only - Family PracticePractitioner - Family Practice 0648245522

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
105768MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ferrell Duncan Clinic, Inc Past Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: candise.kroutil@cernerdirect.coxhealth.com

Organizations & group practices 2

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545868800000",
    "number": "1811930738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9007",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658089007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 E PRIMROSE ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658075155",
            "telephone_number": "417-875-3000",
            "fax_number": "417-875-3383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KROUTIL",
        "first_name": "CANDISE",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2018-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "105768",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "107910",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208688325",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208688317",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.