Individual provider Active NPI

Ted A Harris, MD

  • Obstetrics & Gynecology Physician
  • Marshall, MO
National Provider Identifier
1962467639
Registry record updated Jul 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
2011010497 Issued in MO
Practice address
2301 South 65 Highway
Marshall, MO 65340-3702
Phone
(660) 886-6677
Fax
(660) 886-3346
NPI assigned
Apr 18, 2006
Last updated
Jul 1, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 22265 IA
Obstetrics & Gynecology Physician 207V00000X 2011010497 MO Primary

Addresses

Primary practice location

2301 South 65 Highway
Marshall, MO 65340-3702

Mailing address

2301 South 65 Highway
Marshall, MO 65340-3702
Phone (660) 886-6677

Other identifiers 2

IdentifierTypeStateIssuer
124882OtherHEALTH ALLIANCE
421527584-19OtherJOHN DEERE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20190107001610 VA Practitioner - Obstetrics/Gynecology 6204838907 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
22265IAMDPharmacist

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309478400000",
    "number": "1962467639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 SOUTH 65 HIGHWAY",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403702",
            "telephone_number": "660-886-6677",
            "fax_number": "660-886-3346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 SOUTH 65 HIGHWAY",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403702",
            "telephone_number": "660-886-6677",
            "fax_number": "660-886-3346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "TED",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2011-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IA",
            "license": "22265",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MO",
            "license": "2011010497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "124882",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "421527584-19",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marshall, MO

Sources for this page

Verify at the official NPI Registry.