NPIMap

Individual provider Active NPI

Gordon Reed Wouters, DO

  • Family Medicine Physician
  • Hermitage, MO
National Provider Identifier
1851402010
Registry record updated Jan 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
114045 Issued in MO
Practice address
Hwy 254 & Dallas St.
Hermitage, MO 65668
Phone
(417) 745-2121
Fax
(417) 745-6141
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 114045 MO Primary

Addresses

Primary practice location

Hwy 254 & Dallas St.
Hermitage, MO 65668

Mailing address

1500 N Oakland
Bolivar, MO 65613
Phone (417) 745-2121

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
I20040520001224 MO Practitioner - Family Practice 9537150289 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield Communities 1,121 clinicians

Practice addresses (Care Compare)

309 E Hospital Rd
MC Family Medicine El Dorado SPG
El Dorado Springs, MO 64744-2021
Phone (417) 876-5851

Hospital & facility affiliations

  • Citizens Memorial Home Health Home health agency, Bolivar, MO, CCN 267196
  • St Croix Hospice Hospice, Bolivar, MO, CCN 261630
  • Mercy Hospital Springfield Hospital, Springfield, MO, CCN 260065
  • Cedar County Memorial Hospital Hospital, El Dorado Springs, MO, CCN 261323
  • Citizens Memorial Hospital Hospital, Bolivar, MO, CCN 260195
  • Community Springs Healthcare Facility Nursing home, El Dorado Springs, MO, CCN 265446

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
114045MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities Family Medicine CurrentSince Dec 16, 2024 Accepting new patients
Ozarks Resource Group CurrentSince Feb 9, 2013 Accepting new patients
Ozarks Resource Group CurrentSince Feb 9, 2013 Accepting new patients
Mercy Clinic Springfield Communities Family Medicine CurrentSince Dec 16, 2024 Accepting new patients
Mercy Clinic Springfield Communities Family Medicine CurrentSince Dec 16, 2024 Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients
Buffalo Prairie Nursing and Rehab LLC Past Accepting new patients
N & R of Hermitage LLC Past Accepting new patients

Locations

309 E Hospital Rd
El Dorado Springs, MO 64744
Phone (417) 876-4645

18614 Jackson St
Hermitage, MO 65668
Phone (417) 745-0103

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

Organizations & group practices 8

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262563200000",
    "number": "1851402010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N OAKLAND",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "65613",
            "telephone_number": "417-745-2121",
            "fax_number": "417-745-6141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HWY 254 & DALLAS ST.",
            "city": "HERMITAGE",
            "state": "MO",
            "postal_code": "65668",
            "telephone_number": "417-745-2121",
            "fax_number": "417-745-6141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOUTERS",
        "first_name": "GORDON",
        "middle_name": "REED",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2010-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "114045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hermitage, MO

Sources for this page

Verify at the official NPI Registry.