NPIMap

Individual provider Active NPI

Jennifer Nicole O'Malley, M.D,

  • Family Medicine Physician
  • Saint James, MO
National Provider Identifier
1831458033
Registry record updated Aug 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2015020983 Issued in MO
Practice address
1000 N Jefferson St
Saint James, MO 65559
Phone
(573) 265-8840
Fax
(573) 265-8884
NPI assigned
May 8, 2012
Last updated
Aug 22, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2019

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 2015020983 MO Primary

Addresses

Primary practice location

1000 N Jefferson St
Saint James, MO 65559

Mailing address

1050 W 10TH St
Rolla, MO 65401-2905
Phone (573) 364-9000

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
I20150831001017 MO Practitioner - Family Practice 5193049674 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pcrmc Medical Group IncGroup PAC ID 1557454063, 113 clinicians

Practice addresses (Care Compare)

1000 N Jefferson St
Saint James, MO 65559-1078
Phone (573) 265-8840

1050 W 10TH St
Rolla, MO 65401-2905
Phone (573) 364-9000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2015020983MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pcrmc Medical Group, Inc Current Accepting new patients
Phelps County Regional Medical Center CurrentSince Sep 1, 2015 Accepting new patients
Phelps County Regional Medical Center CurrentSince Sep 1, 2015 Accepting new patients
Phelps County Regional Medical Center CurrentSince Jun 24, 2023 Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients

Locations

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

1050 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

1000 N Jefferson St
Saint James, MO 65559
Phone (573) 265-8840

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 9

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": "1336435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566432000000",
    "number": "1831458033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "573-364-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N JEFFERSON ST",
            "city": "SAINT JAMES",
            "state": "MO",
            "postal_code": "65559",
            "telephone_number": "573-265-8840",
            "fax_number": "573-265-8884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'MALLEY",
        "first_name": "JENNIFER",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "M.D,",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-08",
        "last_updated": "2019-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2015020983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint James, MO

Sources for this page

Verify at the official NPI Registry.