Active NPI
Judith Anne Dasovich, MD
- Internal Medicine Physician
- Strafford, MO
National Provider Identifier
1841386281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- R5061
- Practice address
- 363 East Route 66
Strafford, MO 65757 - Phone
- (417) 736-9837
- Fax
- (417) 736-9839
- NPI assigned
- Oct 5, 2006
- Last updated
- Feb 9, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | R5061 | MO | Primary |
Addresses
Primary practice location
363 East Route 66
Strafford, MO 65757
Mailing address
363 East Route 66
Strafford, MO 65757
Phone (417) 736-9837
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841386281 | Medicaid | MO | |
| 431560263 | Other | TRICARE WEST | |
| P00782623 | Other | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R5061 | MO | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozarks Medical Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Ozarks Healthcare
- General Acute Care Hospital
- West Plains, MO
- NPI 1831115641
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265673600000",
"number": "1841386281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "363 EAST ROUTE 66",
"city": "STRAFFORD",
"state": "MO",
"postal_code": "65757",
"telephone_number": "417-736-9837",
"fax_number": "417-736-9839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "363 EAST ROUTE 66",
"city": "STRAFFORD",
"state": "MO",
"postal_code": "65757",
"telephone_number": "417-736-9837",
"fax_number": "417-736-9839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DASOVICH",
"first_name": "JUDITH",
"middle_name": "ANNE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-05",
"last_updated": "2010-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MO",
"license": "R5061",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1841386281",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE WEST",
"identifier": "431560263",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00782623",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Strafford, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.