NPIMap

Individual provider Active NPI

Peter Jay Cleavinger, MD

  • Gastroenterology Physician
  • Columbia, MO
National Provider Identifier
1841244191
Registry record updated Jun 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
2000163862 Issued in MO
Practice address
210 Portland St
Suite 100
Columbia, MO 65201-6677
Phone
(573) 777-8818
Fax
(573) 777-8819
NPI assigned
May 20, 2006
Last updated
Jun 30, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 2000163862 MO Primary

Addresses

Primary practice location

210 Portland St
Suite 100
Columbia, MO 65201-6677

Mailing address

210 Portland St
Suite 100
Columbia, MO 65201-6677
Phone (573) 777-8818

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
I20100920000516 MO Practitioner - GastroenterologyPractitioner - Internal Medicine 9335108182 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
University of Missouri, Columbia School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
General John J Pershing Memorial Hospital AssociationGroup PAC ID 2860306750, shared by 5 NPIs, 20 clinicians
Gastrointestinal Associates, LLCGroup PAC ID 9537166236, 30 clinicians

Practice addresses (Care Compare)

130 E Lockling St
Brookfield, MO 64628-2337
Phone (660) 258-1278

210 Portland St
Columbia, MO 65201-6677
Phone (573) 777-8818

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy146
Upper gastrointestinal (GI) endoscopy for acid reflux147

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2000163862MOMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Curators of the University of Missouri CurrentSince Jul 1, 2024 Accepting new patients
Curators of the University of Missouri CurrentSince Jul 1, 2024 Accepting new patients
General John J Pershing Memorial Hospital Association CurrentSince Jun 4, 2024 Accepting new patients
Columbia Endoscopy Center, LLC Current Accepting new patients
Boone Physician Services, LLC CurrentSince Jun 12, 2024 Accepting new patients
Gastrointestinal Associates, LLC Gastroenterology CurrentSince Aug 1, 2000 Accepting new patients
General John J Pershing Memorial Hospital Association CurrentSince Jun 4, 2024 Accepting new patients

Locations

130 E Lockling St
Brookfield, MO 64628
Phone (660) 258-1050

1 Hospital Dr
Columbia, MO 65212
Phone (573) 882-2568

101 S Fairview Rd
Columbia, MO 65203
Phone (573) 882-1095

1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000

1705 E Broadway
Ste 280
Columbia, MO 65201
Phone (573) 815-7119

210 Portland St
Ste 100
Columbia, MO 65201
Phone (573) 777-8818

Interoperability endpoints

  • FHIR API: https://ff23a4b4-465d-44fa-a7d8-99a59a9660e5.gastro.prod.fhir.ema-api.com/fhir/r4/

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277856000000",
    "number": "1841244191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 PORTLAND ST",
            "address_2": "SUITE 100",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652016677",
            "telephone_number": "573-777-8818",
            "fax_number": "573-777-8819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 PORTLAND ST",
            "address_2": "SUITE 100",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652016677",
            "telephone_number": "573-777-8818",
            "fax_number": "573-777-8819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEAVINGER",
        "first_name": "PETER",
        "middle_name": "JAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2010-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MO",
            "license": "2000163862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.