Clarissa Jara Allen, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2013027611 Issued in MO

Practice address

225 Clarkson Rd
Ellisville, MO 63011-2278

Phone

(636) 230-5050

Fax

(636) 230-5057

NPI assigned

May 4, 2007

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2019 through Oct 1, 2027

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

• Clarissa Gesmundo Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 11, 2015.

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423612800000",
    "number": "1952513541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 CLARKSON RD",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112278",
            "telephone_number": "636-230-5050",
            "fax_number": "636-230-5057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 CLARKSON RD",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112278",
            "telephone_number": "636-230-5050",
            "fax_number": "636-230-5057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "CLARISSA",
        "middle_name": "JARA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2015-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "41675",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "067878",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2013027611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CLARISSA",
            "last_name": "GESMUNDO",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Aequa Health and Wellness LLC
• Affiliated Hospitals Dialysis Center
• Carrie Ahrens, SLP
• Olivia Beth Albers
• Cyrus M Alizadeh, DDS
• Paula Allison, PT
• Mary Beth H Anderson
• Andrew G. Mitchell, Inc.
• Eric Lee Anspach, PHARMACIST
• Astra Mo Bhe LLC

• All providers in Ellisville, MO
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.