Jeffrey Griesemer, MD
Individual provider Active NPI Family Medicine Physician · Charleston, MO
NPI 1851551907 · NPPES record last updated Oct 22, 2011
Key facts
- NPI
- 1851551907
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 2011002939 (MO)
- Practice address
- 1403 E Marshall St
Charleston, MO 63834 - Phone
- (573) 683-2327
- NPI assigned
- Jun 12, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 20
Hospital & facility affiliations 3
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Loyola University of Chicago, Stritch School of Medicine, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Missouri Delta Medical Center
Health Facilities Rehab Services Inc
Practice addresses (Care Compare)
1008 N Main St
Sikeston, MO 63801-5044
Phone (573) 471-1600
1102 Sikes Ave
Sikeston, MO 63801-5021
Hospital & facility affiliations
- Missouri Delta Medical Center
- Saint Francis Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Elite Hospice |
Hospice | Contracted Managing Employee | Mar 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110801000227 | MO | Practitioner - Family Practice | 2365627247 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2011002939 | MO | MD | Family Medicine Physician |
| 125054803 | IL | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Missouri Delta Medical Center | Current |
Accepting new patients | |
| Missouri Delta Medical Center | Family Medicine | Current |
Accepting new patients |
| Missouri Delta Medical Center | Past | Accepting new patients |
Locations
1403 E Marshall St
Charleston, MO 63834
Phone (573) 683-2327
1008 N Main St
Sikeston, MO 63801
Phone (573) 471-1600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2011002939 | MO | Yes |
| Student in an Organized Health Care Education/Training Program | 390200000X | 125054803 | IL |
Addresses
Primary practice location
1403 E Marshall St
Charleston, MO 63834
Mailing address
1008 N Main St
Sikeston, MO 63801-5044
Phone (573) 683-2327
Other providers in Charleston, MO
- Bianca Daisy
- Amber Nikole Faire
- Ferguson Medical Group Rural Health Center Inc.
- Nicole Larea Gorsuch
- Gregorio L. Rodriguez, M.D., P.C.
- Myra Gunn
- Courtney Hahs
- Judith Hahs
- Michael C Hakala
- Rachel Hanauer
All providers in Charleston, MO · Family Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.