John Robert Sparks, DO
Individual provider Active NPI Family Medicine Physician · Kirksville, MO
NPI 1972609279 · NPPES record last updated Oct 3, 2007
Key facts
- NPI
- 1972609279
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- R5954 (MO)
- Practice address
- 1410 Crown Drive
Kirksville, MO 63501-0703 - Phone
- (660) 665-1400
- Fax
- (660) 665-2081
- NPI assigned
- Sep 15, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200302002062 | MO | Order and Referring Only - Family Practice |
3779610043 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R5954 | MO | Yes |
Addresses
Primary practice location
1410 Crown Drive
Kirksville, MO 63501-0703
Mailing address
PO Box 703
1410 Crown Drive
Kirksville, MO 63501-0703
Phone (660) 665-1400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 273051 | Other | MO | HEALTHLINK |
| 11404039 | Other | MO | BLUE CROSS BLUE SHIELD |
Other providers in Kirksville, MO
- Carolyn Allisa Snyder
- Karlie Ann Snyder
- Sherre A Snyder
- Brandon Jeremy Sorhus
- Sparks Clinic P.C.
- Megan Sparks
- Robert W Sparks
- Brent D Speak
- Speech and Language With a Little TLC LLC
- Speech-Language and Learning Services LLC
All providers in Kirksville, MO · Family Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.