John Quincy Elliott, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2005039927 Issued in MO

Practice address

2480 Three Rivers Blvd
Poplar Bluff, MO 63901-2318

Phone

(573) 785-4600

Fax

(573) 785-4611

NPI assigned

Aug 16, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, 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.

• Potosi Emergency Group, LLC

  • Emergency Medicine Physician
  • Potosi, MO
  • NPI 1881075349

  MO

  Medicare reassignment NPD
• Ozarks Medical Center

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

  Family Medicine

  NPD (past)
• Poplar Bluff Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Poplar Bluff, MO
  • NPI 1679822647
  NPD (past)
• TH Contracting Services of Missouri

  • Emergency Medicine Physician
  • Poplar Bluff, MO
  • NPI 1174570055
  NPD (past)

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432080000000",
    "number": "1922090125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2480 THREE RIVERS BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012318",
            "telephone_number": "573-785-4600",
            "fax_number": "573-785-4611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 THREE RIVERS BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012318",
            "telephone_number": "573-785-4600",
            "fax_number": "573-785-4611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "JOHN",
        "middle_name": "QUINCY",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2015-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02002722A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2005039927",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200111230A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jimmy H Elam, OD
• Courtney Elder
• Michelle Elder
• Elite Obstetrics and Gynecology LLC
• Cynthia J Elliott, LCSW
• Theresa Ann Elliott
• Wendell H Elliott, MD
• Ashley E Ellison
• Brittany Marie Ellison
• Amber Dawn Elsworth

• Family Medicine Physician in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; 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.