Individual provider Active NPI

Eduard Rasputkov

  • Adult Medicine Physician
  • Kirksville, MO
National Provider Identifier
1912400763
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
2023029983 Issued in MO
Practice address
800 W Jefferson St
Kirksville, MO 63501-1443
Phone
(660) 626-2121
NPI assigned
Mar 16, 2018
Last updated
May 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X 2023029983 MO Primary

Addresses

Primary practice location

800 W Jefferson St
Kirksville, MO 63501-1443

Mailing address

803 N Osteopathy
Kirksville, MO 63501-1367

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240627000960 MO Practitioner - Family Practice 5294150710 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Western Un of HLTH Sciences, Col of Podiatric Med, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bothwell Regional Health CenterGroup PAC ID 6103714126, 109 clinicians

Practice addresses (Care Compare)

3131 Brianna Blvd
Sedalia, MO 65301-2285
Phone (660) 827-7925

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bothwell Regional Health Center Current Accepting new patients
Bothwell Regional Health Center CurrentSince Jun 1, 2024 Accepting new patients
Bothwell Regional Health Center CurrentSince Jun 1, 2024 Accepting new patients

Locations

3131 Brianna Blvd
Sedalia, MO 65301
Phone (660) 460-3038

601 E 14th St
Sedalia, MO 65301
Phone (660) 826-8833

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1521158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1912400763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 N OSTEOPATHY",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635011367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 W JEFFERSON ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635011443",
            "telephone_number": "660-626-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RASPUTKOV",
        "first_name": "EDUARD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-16",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "MO",
            "license": "2023029983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirksville, MO

Sources for this page

Verify at the official NPI Registry.