NPIMap

Organization Active NPI

Bothwell Regional Health Center

  • Surgery Physician
  • Sedalia, MO
National Provider Identifier
1891040317
Registry record updated Apr 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
BOTHWELL REGIONAL HEALTH CENTER
Practice address
3300 W 10TH St
Sedalia, MO 65301-2111
Phone
(660) 827-0423
Fax
(660) 827-5510
NPI assigned
Jul 20, 2012
Organization subpart
Yes
Parent organization
BOTHWELL REGIONAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 17, 2014

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

Authorized official

Name
James A Robertson
Title
Cfo
Phone
(660) 827-9482

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

3300 W 10TH St
Sedalia, MO 65301-2111

Mailing address

601 E 14TH St
PO Box 1706
Sedalia, MO 65301-5972
Phone (660) 826-8833

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidMO

Other names 1

  • Bothwell Surgical Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310000246 MO Part B Supplier - Clinic/Group Practice 6103714126 Receives reassigned benefits from 206 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Warsaw, MO; Sedalia, MO; Lincoln, MO; Cole Camp, MO

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Part of
Osage Valley Medical Ce

Locations

3300 W 10th St
Sedalia, MO 65301
Phone (660) 827-0423

NPI Registry JSON

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

{
    "created_epoch": "1342742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397692800000",
    "number": "1891040317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E 14TH ST",
            "address_2": "PO BOX 1706",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653015972",
            "telephone_number": "660-826-8833",
            "fax_number": "660-827-3742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 W 10TH ST",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653012111",
            "telephone_number": "660-827-0423",
            "fax_number": "660-827-5510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOTHWELL REGIONAL HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOTHWELL REGIONAL HEALTH CENTER",
        "enumeration_date": "2012-07-20",
        "last_updated": "2014-04-17",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "660-827-9482"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bothwell Surgical Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sedalia, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2014; 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.