Individual provider Active NPI

Traci Marie Kristofik, DO

  • Internal Medicine Physician
  • Sedalia, MO
National Provider Identifier
1962856963
Registry record updated Jun 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2019008366 Issued in MO
Practice address
601 E 14TH St
Sedalia, MO 65301-5972
Phone
(660) 826-8833
NPI assigned
Apr 16, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2019008366 MO Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

601 E 14TH St
Sedalia, MO 65301-5972

Mailing address

601 E 14TH St
Sedalia, MO 65301-5972

Other practice location 1

3214 E Race Ave
Searcy, AR 72143-4810
Phone (501) 380-2299

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
I20190819000456 MO Practitioner - Internal Medicine 8527396357 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bothwell Regional Health CenterGroup PAC ID 6103714126, 109 clinicians

Practice addresses (Care Compare)

601 E 14TH St
Bothwell Regional Health Center
Sedalia, MO 65301-5972
Phone (660) 826-8833

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bothwell Regional Health Center Current Accepting new patients
Bothwell Regional Health Center CurrentSince Aug 1, 2019 Accepting new patients
Bothwell Regional Health Center CurrentSince Aug 1, 2019 Accepting new patients

Locations

601 E 14th St
Sedalia, MO 65301
Phone (660) 826-8833

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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": "1460764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1962856963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E 14TH ST",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653015972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E 14TH ST",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653015972",
            "telephone_number": "660-826-8833"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3214 E Race Ave",
            "address_purpose": "LOCATION",
            "city": "Searcy",
            "state": "AR",
            "postal_code": "721434810",
            "country_code": "US",
            "telephone_number": "501-380-2299",
            "fax_number": "501-380-2282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRISTOFIK",
        "first_name": "TRACI",
        "middle_name": "MARIE",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-16",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2019008366",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sedalia, MO

Sources for this page

Verify at the official NPI Registry.