NPIMap

Individual provider Active NPI

Russell D Deidiker, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Farmington, MO
National Provider Identifier
1841265345
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
113238 Issued in MO
Practice address
1212 Weber Rd
Suite 205
Farmington, MO 63640-3325
Phone
(573) 756-4581
Fax
(573) 756-7197
NPI assigned
Feb 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 113238 MO Primary

Addresses

Primary practice location

1212 Weber Rd
Suite 205
Farmington, MO 63640-3325

Mailing address

312 Louise St
Farmington, MO 63640-2706
Phone (573) 756-4581

Other identifiers 1

IdentifierTypeStateIssuer
208729707MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL, IA3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20100901000907 MO Practitioner - Pathology 0547384224 Reassigns benefits to 3 organizations
I20200922000744 IL Practitioner - Pathology 0547384224
I20210505001752 IA Practitioner - Pathology 0547384224 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Tennessee, HSC, College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid-America Pathology Consultants, LLCGroup PAC ID 0648569210, 2 clinicians

Practice addresses (Care Compare)

1101 W Liberty St
Parkland HLTH Ctr
Farmington, MO 63640-1921
Phone (573) 756-6451

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Digestive Disease Specialists PC CurrentSince May 19, 2020 Accepting new patients
Iowa Digestive Disease Center P.C. CurrentSince Apr 1, 2021 Accepting new patients
Mid-America Pathology Consultants, LLC Anatomic Pathology & Clinical Pathology CurrentSince Mar 28, 2016 Accepting new patients
Southeast Missouri Hospital Physicians, LLC CurrentSince Jan 23, 2017 Accepting new patients

Locations

4500 Utica Ridge Rd
Bettendorf, IA 52722
Phone (563) 742-2724

1378 NW 124th St
Ste 200
Clive, IA 50325
Phone (515) 288-6097

3400 Dexter Ct
Ste 108
Davenport, IA 52807
Phone (563) 345-2438

525 Valley View Dr
Moline, IL 61265
Phone (309) 601-2800

1701 Lacey St
Cpe Girardeau, MO 63701
Phone (573) 334-4822

1101 W Liberty St
Farmington, MO 63640
Phone (573) 705-1272

10854 Midwest Industrial Blvd
Saint Louis, MO 63132
Phone (314) 200-3040

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1140393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1841265345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 LOUISE ST",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636402706",
            "telephone_number": "573-756-4581",
            "fax_number": "573-756-7197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 WEBER RD",
            "address_2": "SUITE 205",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636403325",
            "telephone_number": "573-756-4581",
            "fax_number": "573-756-7197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEIDIKER",
        "first_name": "RUSSELL",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-20",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MO",
            "license": "113238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208729707",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, MO

Sources for this page

Verify at the official NPI Registry.