Individual provider Active NPI

Dorothy M Munch, D.O.

  • Family Medicine Physician
  • Poplar Bluff, MO
National Provider Identifier
1922003276
Registry record updated Aug 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
36720 Issued in MO
Practice address
930 N Westwood Blvd
Poplar Bluff, MO 63901-4242
Phone
(573) 778-1620
Fax
(573) 778-1486
NPI assigned
Jun 14, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 15, 2024

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 36720 MO Primary

Addresses

Primary practice location

930 N Westwood Blvd
Poplar Bluff, MO 63901-4242

Mailing address

930 N Westwood Blvd
Poplar Bluff, MO 63901-4242
Phone (573) 778-1620

Other identifiers 8

IdentifierTypeStateIssuer
915331OtherMOUNITED HEALTHCARE ID #
242613081MedicaidMO
1922003276OtherMONPI NUMBER
26D1003101OtherMOCLIA CERTIFICATION NUMBER
242613073MedicaidMO
164653OtherMOBLUE CROSS BLUE SHIELD
460494181OtherMOTAX IDENTIFICATION NUMBER
000000E14668OtherMOPREMIER BENEFITS ID #

Other names 1

  • Mrs. Dorothy M Munch Professional name

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
I20050520000001 MO Practitioner - Family Practice 3274574181 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

930 N Westwood Blvd
Poplar Bluff, MO 63901-4242
Phone (573) 778-1620

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
19.77 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
65.9

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36720MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ozarks Medical Center Family Medicine Past Accepting new patients

Organizations & group practices 2

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 1

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": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1922003276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639014242",
            "telephone_number": "573-778-1620",
            "fax_number": "573-778-1486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639014242",
            "telephone_number": "573-778-1620",
            "fax_number": "573-778-1486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNCH",
        "first_name": "DOROTHY",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-14",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "36720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE ID #",
            "identifier": "915331",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "242613081",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1922003276",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA CERTIFICATION NUMBER",
            "identifier": "26D1003101",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "242613073",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "164653",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION NUMBER",
            "identifier": "460494181",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMIER BENEFITS ID #",
            "identifier": "000000E14668",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DOROTHY",
            "last_name": "MUNCH",
            "middle_name": "M",
            "prefix": "MRS.",
            "credential": "D.O.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

Verify at the official NPI Registry.