NPIMap

Individual provider Active NPI

Eric K Davis, DO

  • Family Medicine Physician
  • Fredericktown, MO
National Provider Identifier
1932277498
Registry record updated Feb 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
114326 Issued in MO
Practice address
611 W Main St
Fredericktown, MO 63645-1111
Phone
(573) 783-4111
Fax
(573) 783-1096
NPI assigned
Dec 1, 2006
Last updated
Feb 27, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2009

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 114326 MO Primary

Addresses

Primary practice location

611 W Main St
Fredericktown, MO 63645-1111

Mailing address

611 W Main St
Fredericktown, MO 63645-1111
Phone (573) 783-5480

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050720000101 MO Practitioner - Family Practice 3173550399 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

611 W Main St
Fredericktown, MO 63645-1111
Phone (573) 783-3341

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
114326MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Madison Medical Center Stockhoff Memorial Nursing Home CurrentSince Sep 1, 2005 Accepting new patients
Madison Medical Center Stockhoff Memorial Nursing Home CurrentSince Sep 1, 2005 Accepting new patients
Madison Medical Center Stockhoff Memorial Nursing Home Past Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients

Locations

611 W Main St
Fredericktown, MO 63645
Phone (573) 773-7061

611 W Main St
Ste A
Fredericktown, MO 63645
Phone (225) 783-5548

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Serenity HospicecarePark Hills, MO, CCN 261554 Hospice Corporate Director Nov 30, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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 5

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": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235692800000",
    "number": "1932277498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W MAIN ST",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451111",
            "telephone_number": "573-783-5480",
            "fax_number": "573-783-1096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W MAIN ST",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451111",
            "telephone_number": "573-783-4111",
            "fax_number": "573-783-1096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "ERIC",
        "middle_name": "K",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2009-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "114326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericktown, MO

Sources for this page

Verify at the official NPI Registry.