Individual provider Active NPI

Kody Blake Finstad, M.D.

  • Pediatrics Physician
  • Nixa, MO
National Provider Identifier
1932396777
Registry record updated Jul 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2007015054 Issued in MO
Practice address
940 W Mount Vernon St Ste 220
Nixa, MO 65714
Phone
(417) 724-5437
Fax
(417) 724-5433
NPI assigned
Sep 25, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2007015054 MO Primary

Addresses

Primary practice location

940 W Mount Vernon St Ste 220
Nixa, MO 65714

Mailing address

940 W Mount Vernon St Ste 220
Nixa, MO 65714-9613
Phone (417) 724-5437

Other identifiers 1

IdentifierTypeStateIssuer
1932396777MedicaidMO

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
I20100813001029 MO Practitioner - Pediatric Medicine 5890829717 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2007015054MOMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Jul 1, 2010 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jul 1, 2010 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jul 1, 2010 Accepting new patients
Mercy Hospital Springfield Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

940 W Mount Vernon St
Ste 220
Nixa, MO 65714
Phone (417) 724-5437

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

620 S Glenstone Ave
Springfield, MO 65802
Phone (417) 829-4215

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

Interoperability endpoints

  • Direct secure messaging: kfinstad158541@directb.mercy.net
  • Direct secure messaging: kfinstad168574@directc.mercy.net

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530489600000",
    "number": "1932396777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 W MOUNT VERNON ST STE 220",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "657149613",
            "telephone_number": "417-724-5437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 W MOUNT VERNON ST STE 220",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "65714",
            "telephone_number": "417-724-5437",
            "fax_number": "417-724-5433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FINSTAD",
        "first_name": "KODY",
        "middle_name": "BLAKE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-25",
        "last_updated": "2018-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2007015054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1932396777",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nixa, MO

Sources for this page

Verify at the official NPI Registry.