Deanna Maria Siemer, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

106442 Issued in MO

Practice address

2685 East Main
Ste a
Jackson, MO 63755

Phone

(573) 204-1400

Fax

(573) 204-1480

NPI assigned

Mar 6, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Rural health clinic certification: CCN 793807

Legal name

DEANNA M SIEMER

Doing business as

JACKSON PRIMARY CARE LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Dec 29, 2010

Last certification

Jun 5, 2024

Ownership / control type

1B

Organization structure

Sole ProprietorProprietary

Incorporated

Dec 29, 2010 in MO

Enrollment address

2685 E Main St
Ste a
Jackson, MO 63755-2474

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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.

• Jackson Primary Care LLC

  • Family Medicine Physician
  • Jackson, MO
  • NPI 1619961380
  Medicare reassignment NPD Authorized official
• Jackson Primary Care LLC

  • Primary Care Clinic/Center
  • Jackson, MO
  • NPI 1790213676

  Rural Health

  NPD
• Southeast Hospital

  • General Acute Care Hospital
  • Cape Girardeau, MO
  • NPI 1811006661
  NPD (past)

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

{
    "created_epoch": "1141603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286409600000",
    "number": "1851368153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2685 EAST MAIN",
            "address_2": "STE A",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "63755",
            "telephone_number": "573-204-1400",
            "fax_number": "573-204-1480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2685 EAST MAIN",
            "address_2": "STE A",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "63755",
            "telephone_number": "573-204-1400",
            "fax_number": "573-204-1480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIEMER",
        "first_name": "DEANNA",
        "middle_name": "MARIA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-06",
        "last_updated": "2010-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "106442",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MO",
            "license": "106442",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": "106442",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "331735",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "109627",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208495622",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Semo Options, Inc.
• Semo Physical Therapy
• Kylie B Seyer
• Kayleen Marie Shaw, LCSW
• Amanda Claire Siemer, O.T.
• Ashlee Sitze
• Kayla Michelle Smith
• Melinda Sue Sorbello, FNP-BC
• Sos Medical Inc
• Sounds of Mind Counseling

• Family Medicine Physician in Jackson, MO
• Providers in Jackson, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.