Jonathan Dale Privett, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2003001992 Issued in MO

Practice address

156 Missouri Blvd
Ste B
Laurie, MO 65038

Phone

(573) 374-5263

Fax

(573) 374-4933

NPI assigned

Jun 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Freeman-Oak Hill Health System

  • General Acute Care Hospital
  • Joplin, MO
  • NPI 1891809679

  MO

  Medicare reassignment NPD
• Freeman-Oak Hill Health System

  • Multi-Specialty Clinic/Center
  • Joplin, MO
  • NPI 1679517023

  Family Medicine

  NPD
• Lake Regional Health System

  • Rural Health Clinic/Center
  • Laurie, MO
  • NPI 1427162254
  NPD (past)
• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641

  Family Medicine

  NPD (past)
• Poplar Bluff Regional Medical Center

  • Community/Retail Pharmacy
  • Piedmont, MO
  • NPI 1205879426
  NPD (past)
• Poplar Bluff Regional Medical Center LLC

  • General Acute Care Hospital
  • Poplar Bluff, MO
  • NPI 1700831724
  NPD (past)
• TH Contracting Services of Missouri

  • Emergency Medicine Physician
  • Poplar Bluff, MO
  • NPI 1174570055

  Emergency Medicine

  NPD (past)

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525651200000",
    "number": "1912945957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 HOSPITAL DR",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653050",
            "telephone_number": "573-348-8399",
            "fax_number": "573-348-8309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 MISSOURI BLVD",
            "address_2": "STE B",
            "city": "LAURIE",
            "state": "MO",
            "postal_code": "65038",
            "telephone_number": "573-374-5263",
            "fax_number": "573-374-4933"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2333 Highway 17",
            "address_purpose": "LOCATION",
            "city": "Iberia",
            "state": "MO",
            "postal_code": "654869331",
            "country_code": "US",
            "telephone_number": "573-793-6900",
            "fax_number": "573-793-6688",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRIVETT",
        "first_name": "JONATHAN",
        "middle_name": "DALE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2018-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2003001992",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2003001992",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912945957",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207431909",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lake Regional Health System
• Laurie Care Center
• Laurie Family Eyecare, Inc.
• Laurie Knolls
• David Gerard Mook, M.D.
• Ragain Chiropractic Clinic PC
• Richard Ragain, CHIROPRACTOR
• Angela Torres
• Westside Rehab, Inc
• John D Wildgen, DDSPC

• All providers in Laurie, MO
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.