NPIMap

Organization Active NPI

Phoenix Home Care, LLC

  • Nurse Practitioner
  • Springfield, MO
National Provider Identifier
1841881869
Registry record updated Dec 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
PHOENIX HOME CARE, LLC
Practice address
1839 E Independence St Ste K
Springfield, MO 65804-3753
Phone
(417) 881-7442
NPI assigned
Feb 2, 2021
Last updated
Dec 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2021

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

Authorized official

Name
George Scott Herman
Title
President & Secretary
Phone
(903) 390-4040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X Primary

Addresses

Primary practice location

1839 E Independence St Ste K
Springfield, MO 65804-3753

Mailing address

3450 N. Rock Rd.
#213, Attn: Debra Mullen
Witchita, KS 67226-1352
Phone (316) 688-5511

Other identifiers 1

IdentifierTypeStateIssuer
MA7399OtherMOMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190508003233 MO Part B Supplier - Clinic/Group Practice 4183896004 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Springfield, MO

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Phoenix Home Care Inc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639094400000",
    "number": "1841881869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 N. ROCK RD.",
            "address_2": "#213, ATTN: DEBRA MULLEN",
            "city": "WITCHITA",
            "state": "KS",
            "postal_code": "672261352",
            "telephone_number": "316-688-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1839 E INDEPENDENCE ST STE K",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658043753",
            "telephone_number": "417-881-7442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX HOME CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-02",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A",
        "authorized_official_last_name": "HERMAN",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT & SECRETARY",
        "authorized_official_telephone_number": "903-390-4040"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "MA7399",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.