NPIMap

Individual provider Active NPI

Mariah Stacy Gann, PA-C

  • Medical Physician Assistant
  • Columbia, MO
National Provider Identifier
1851077408
Registry record updated Aug 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
525 N Keene St Ste 301
Columbia, MO 65201-8106
Phone
(573) 449-2141
Fax
(573) 556-1750
NPI assigned
Jun 27, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 20, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Medical Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363AM0700X Primary

Addresses

Primary practice location

525 N Keene St Ste 301
Columbia, MO 65201-8106

Mailing address

1241 W Stadium Blvd
Jefferson City, MO 65109-6023

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
I20250506001026 MO Practitioner - Physician Assistant 2264959089 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson City Medical Group PCGroup PAC ID 1850371089, 117 clinicians

Practice addresses (Care Compare)

1241 W Stadium Blvd
Jefferson City, MO 65109-6023
Phone (573) 556-5771

525 N Keene St
Suite 301
Columbia, MO 65201-6967
Phone (573) 449-2141

Hospital & facility affiliations

  • Boone Hospital Center Hospital, Columbia, MO, CCN 260068
  • University of Missouri Health Care Hospital, Columbia, MO, CCN 260141

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson City Medical Group, P.C. Single Specialty CurrentSince May 1, 2025 Accepting new patients
Jefferson City Medical Group, P.C. Single Specialty CurrentSince May 1, 2025 Accepting new patients
Jefferson City Medical Group, P.C. Single Specialty Current Accepting new patients
Jefferson City Medical Group, P.C. Current Accepting new patients
Unmc Physicians Single Specialty PastSince Jul 1, 2023 Accepting new patients
Jefferson City Medical Group, P.C. Single Specialty Past Accepting new patients
Nebraska Pediatric Practice, Inc Single Specialty PastSince Jul 1, 2023 Accepting new patients

Locations

525 N Keene St
Ste 301
Columbia, MO 65201
Phone (573) 239-8404

1241 W Stadium Blvd
Jefferson Cty, MO 65109
Phone (573) 556-5771

Interoperability endpoints

  • Direct secure messaging: mariah.gann@jcmg.eclinicaldirectplus.com

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1687824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755648000000",
    "number": "1851077408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1241 W STADIUM BLVD",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N KEENE ST STE 301",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652018106",
            "telephone_number": "573-449-2141",
            "fax_number": "573-556-1750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANN",
        "first_name": "MARIAH",
        "middle_name": "STACY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-27",
        "last_updated": "2025-08-20",
        "certification_date": "2025-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.