John D Despain, M.D.
Individual provider Active NPI Dermatology Physician · Osage Beach, MO
NPI 1932196433 · NPPES record last updated Aug 14, 2024
Key facts
- NPI
- 1932196433
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- R8E64 (MO)
- Practice address
- 5721 Osage Beach Pkwy Ste 100
Osage Beach, MO 65065-3030 - Phone
- (573) 302-4696
- Fax
- (573) 302-4698
- NPI assigned
- Sep 30, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Dermatology
- Education
- University of Missouri, Columbia School of Medicine, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Forefront Dermatology SC
Practice addresses (Care Compare)
5721 Osage Beach Pkwy
Suite 100
Osage Beach, MO 65065-3030
Phone (573) 302-4696
Hospital & facility affiliations
- Lake Regional Health System
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 103 |
| Removal of skin lesions | 980 |
| Removal or shaving of skin growth | 42 |
| Skin biopsy | 209 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070814000590 | MO | Practitioner - Dermatology | 5597768986 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R8E64 | MO | MD | Dermatopathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jefferson City Medical Group, P.C. | Current | Accepting new patients | |
| Forefront Dermatology, S.C. | Dermatology | Current |
Accepting new patients |
| Forefront Dermatology, S.C. | Dermatology | Current |
Accepting new patients |
| Jefferson City Medical Group, P.C. | Current | Accepting new patients | |
| Jefferson City Medical Group, P.C. | Current |
Accepting new patients | |
| Jefferson City Medical Group, P.C. | Current |
Accepting new patients | |
| Forefront Dermatology, S.C. | Dermatology | Past | Accepting new patients |
| Forefront Dermatology, S.C. | Dermatology | Past | Accepting new patients |
Locations
200 Portland St
Columbia, MO 65201
Phone (573) 886-4600
1223 Maple St
Farmington, MO 63640
Phone (573) 760-0091
3605 Country Club Dr
Jefferson City, MO 65109
Phone (573) 634-4878
1735 Elm Ct
Jefferson Cty, MO 65101
Phone (573) 634-4878
1241 W Stadium Blvd
Jefferson Cty, MO 65109
Phone (573) 556-5771
5721 Osage Beach Pkwy
Ste 100
Osage Beach, MO 65065
Phone (573) 302-4696
801 York St
Manitowoc, WI 54220
Phone (866) 630-9882
Interoperability endpoints
- john.despain@forefrontdermatology.emadirect.md
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatopathology Physician | 207ND0900X | R8E64 | MO | |
| Dermatology Physician | 207N00000X | R8E64 | MO | Yes |
Addresses
Primary practice location
5721 Osage Beach Pkwy Ste 100
Osage Beach, MO 65065-3030
Mailing address
801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9008
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | John.DeSpain@forefrontdermatology.emadirect.md |
Other providers in Osage Beach, MO
- Columbia Orthopaedic Group, LLP
- Jasha B Conner
- Bradley D. Connett
- Laura Davis
- Kim Ann Dempsey
- Thomas A Dettmer
- James D Dexter
- Dialysis Clinic Inc.
- Dialysis Clinic Inc.
- Kasi Jamel Dibello
All providers in Osage Beach, MO · Dermatology Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.