| Jordan Valley Community Health Center | |
|
440 E Tampa St Springfield MO 65806-1131 | |
| (417) 831-0150 | |
| (417) 831-0155 |
| Full Name | Jordan Valley Community Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 440 E Tampa St, Springfield, Missouri |
| Authorized Official Name and Position | Kenneth Brooks Miller (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4178310150 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jordan Valley Community Health Center 440 E Tampa St Springfield MO 65806-1131 Ph: (417) 851-1551 | Jordan Valley Community Health Center 440 E Tampa St Springfield MO 65806-1131 Ph: (417) 831-0150 |
| NPI Number | 1558303057 |
|---|---|
| Provider Enumeration Date | 06/11/2006 |
| Last Update Date | 12/02/2021 |
| Medicare PECOS PAC ID | 5395653562 |
|---|---|
| Medicare Enrollment ID | O20041109000631 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558303057 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Carlin A Ridpath |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497715080 PECOS PAC ID: 3870406697 Enrollment ID: I20031107000570 |
| Provider Name | William M Zeller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356386502 PECOS PAC ID: 2264320902 Enrollment ID: I20040308000224 |
| Provider Name | Randall K Booth |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1871552596 PECOS PAC ID: 5092791806 Enrollment ID: I20040624000584 |
| Provider Name | James Mccaul |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1326197997 PECOS PAC ID: 8820906266 Enrollment ID: I20040714001552 |
| Provider Name | Karrie A Cunningham |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1285770040 PECOS PAC ID: 3274512140 Enrollment ID: I20040714001585 |
| Provider Name | Elizabeth Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972612117 PECOS PAC ID: 9335113794 Enrollment ID: I20040823000012 |
| Provider Name | Matthew Stinson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366533937 PECOS PAC ID: 4688648850 Enrollment ID: I20040824000041 |
| Provider Name | Chan K Reyes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497863161 PECOS PAC ID: 2567425663 Enrollment ID: I20041110000001 |
| Provider Name | Brendon Delport |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1194721100 PECOS PAC ID: 4789677188 Enrollment ID: I20050314000087 |
| Provider Name | Charles S Rasmussen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891826269 PECOS PAC ID: 1254363393 Enrollment ID: I20050909000010 |
| Provider Name | Frank A Cornella |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1356322838 PECOS PAC ID: 9739107947 Enrollment ID: I20051109000091 |
| Provider Name | Manuel Camejo |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1225016637 PECOS PAC ID: 3375559438 Enrollment ID: I20060227000401 |
| Provider Name | Gabrielle I Curtis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326076993 PECOS PAC ID: 5294733705 Enrollment ID: I20061116000528 |
| Provider Name | Elizabeth N Stobbe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609874262 PECOS PAC ID: 7517969553 Enrollment ID: I20070205000532 |
| Provider Name | Clint A Strong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093806671 PECOS PAC ID: 9931101474 Enrollment ID: I20070213000005 |
| Provider Name | Cindra E Tull |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558552091 PECOS PAC ID: 8921195165 Enrollment ID: I20071105000093 |
| Provider Name | Louis J Delcampo |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1871779405 PECOS PAC ID: 4688757909 Enrollment ID: I20080211000172 |
| Provider Name | Kyle W Griffin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710076948 PECOS PAC ID: 7012092216 Enrollment ID: I20080312000411 |
| Provider Name | Rafael Santiago |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174517825 PECOS PAC ID: 2769378199 Enrollment ID: I20080630000392 |
| Provider Name | Barbara Wachtel-nash |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750352670 PECOS PAC ID: 1456424803 Enrollment ID: I20080718000376 |
| Provider Name | Giovanni Safdari |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1053574517 PECOS PAC ID: 8628142940 Enrollment ID: I20080805000641 |
| Provider Name | Charles S Harriman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033221353 PECOS PAC ID: 9032285150 Enrollment ID: I20080913000048 |
| Provider Name | Kayce Morton |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1558463620 PECOS PAC ID: 1254408578 Enrollment ID: I20080927000222 |
| Provider Name | Joe E Himes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063546398 PECOS PAC ID: 7517021900 Enrollment ID: I20090129000572 |
| Provider Name | Joyce D Ries |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578611687 PECOS PAC ID: 5092870618 Enrollment ID: I20090216000266 |
| Provider Name | Stephanie L Swords |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215071709 PECOS PAC ID: 2062566599 Enrollment ID: I20090819000123 |
| Provider Name | Amanda J Milligan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770807737 PECOS PAC ID: 2466583935 Enrollment ID: I20100628000038 |
| Provider Name | Emily H Mebruer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912043316 PECOS PAC ID: 7517090756 Enrollment ID: I20100809000557 |
| Provider Name | Shelby R Hahn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881875771 PECOS PAC ID: 4880728674 Enrollment ID: I20100816000636 |
| Provider Name | Christina M Moellering |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1871684654 PECOS PAC ID: 1052445715 Enrollment ID: I20100817000445 |
| Provider Name | Audrey M Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215118195 PECOS PAC ID: 5698809366 Enrollment ID: I20100817000604 |
| Provider Name | Kelly D Wright |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710089685 PECOS PAC ID: 8224162995 Enrollment ID: I20100817000608 |
| Provider Name | Autumn M Clark |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912911090 PECOS PAC ID: 6103950415 Enrollment ID: I20100820001116 |
| Provider Name | Daniel D Meadows |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1205038874 PECOS PAC ID: 1254523129 Enrollment ID: I20101011000478 |
| Provider Name | Laura J Isaacson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760611917 PECOS PAC ID: 3678769494 Enrollment ID: I20101118001392 |
| Provider Name | Christine M Saxton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578865911 PECOS PAC ID: 8921286634 Enrollment ID: I20110629000018 |
| Provider Name | Matthew Steven Cherry |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457376865 PECOS PAC ID: 9638115009 Enrollment ID: I20110812000481 |
| Provider Name | Elizabeth E Lucore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427212083 PECOS PAC ID: 3476723222 Enrollment ID: I20110902000417 |
| Provider Name | Laura Luehr |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1922214824 PECOS PAC ID: 2860672789 Enrollment ID: I20110915000217 |
| Provider Name | Dawn R Dean |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720386659 PECOS PAC ID: 3779754742 Enrollment ID: I20110922000790 |
| Provider Name | Jon E Treadway |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1053346387 PECOS PAC ID: 9234397126 Enrollment ID: I20120223000438 |
| Provider Name | Brian M Braumiller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710181029 PECOS PAC ID: 5799751855 Enrollment ID: I20120529000220 |
| Provider Name | Melissa K Belles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356697114 PECOS PAC ID: 7416106752 Enrollment ID: I20121002000644 |
| Provider Name | Jade N Manczuk |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1124377395 PECOS PAC ID: 7416107925 Enrollment ID: I20121018000364 |
| Provider Name | Linda Y Climer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992802219 PECOS PAC ID: 0446484802 Enrollment ID: I20131018000380 |
| Provider Name | Amanda S Gilbert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750717385 PECOS PAC ID: 2860629938 Enrollment ID: I20131217000389 |
| Provider Name | Brandon M Trumble |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972932853 PECOS PAC ID: 4284862335 Enrollment ID: I20140116001310 |
| Provider Name | Ashlee L Rossner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912320862 PECOS PAC ID: 2466682430 Enrollment ID: I20140313001490 |
| Provider Name | Justin Pham |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1821040866 PECOS PAC ID: 0042104754 Enrollment ID: I20140516001003 |
| Provider Name | David I Nawoor |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1770871642 PECOS PAC ID: 4284852914 Enrollment ID: I20140821001830 |
| Provider Name | Tehesha S Stegall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265841597 PECOS PAC ID: 2163641879 Enrollment ID: I20140911000884 |
| Provider Name | Netti Summer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811246374 PECOS PAC ID: 3779736772 Enrollment ID: I20141205001500 |
| Provider Name | Christopher M Ward |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1245631340 PECOS PAC ID: 0648599795 Enrollment ID: I20150512001422 |
| Provider Name | Somer A Norman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730566969 PECOS PAC ID: 2567773120 Enrollment ID: I20150623002119 |
| Provider Name | Jose S Padilla |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1265449755 PECOS PAC ID: 7416144290 Enrollment ID: I20150625002335 |
| Provider Name | Katie L Davenport-kabonic |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205190931 PECOS PAC ID: 9133434707 Enrollment ID: I20150812007368 |
| Provider Name | Kelsey L Orr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255715058 PECOS PAC ID: 8224343355 Enrollment ID: I20150818004784 |
| Provider Name | Michelle Marie Spencer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003282864 PECOS PAC ID: 5092022681 Enrollment ID: I20150915000701 |
| Provider Name | Billie A Scott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073994224 PECOS PAC ID: 6709193287 Enrollment ID: I20150916000435 |
| Provider Name | Stephanie R Gerlek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285910869 PECOS PAC ID: 2860616109 Enrollment ID: I20151103003071 |
| Provider Name | Emily E Woolf |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689954737 PECOS PAC ID: 6800106832 Enrollment ID: I20151104000091 |
| Provider Name | Andrew Benbow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073953626 PECOS PAC ID: 3779887021 Enrollment ID: I20160404000055 |
| Provider Name | Kia D Washington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922468305 PECOS PAC ID: 7315245719 Enrollment ID: I20160419001239 |
| Provider Name | Rachel M Archer |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1841558921 PECOS PAC ID: 3375846157 Enrollment ID: I20160729000635 |
| Provider Name | Jennifer Vong |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1952669715 PECOS PAC ID: 6709170731 Enrollment ID: I20160812001943 |
| Provider Name | Joshua Zinner |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1740443449 PECOS PAC ID: 1658666359 Enrollment ID: I20160819000598 |
| Provider Name | Nastassia Bommel |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1427497411 PECOS PAC ID: 6800181314 Enrollment ID: I20160823002267 |
| Provider Name | Jessica D Standeford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326482530 PECOS PAC ID: 8820384431 Enrollment ID: I20160908000703 |
| Provider Name | Carrisann T Woods |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1316210404 PECOS PAC ID: 6305140849 Enrollment ID: I20160919001850 |
| Provider Name | Sara Ashley Warren |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952742595 PECOS PAC ID: 0042508129 Enrollment ID: I20161005000123 |
| Provider Name | Amanda Hyde |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427507466 PECOS PAC ID: 3173811775 Enrollment ID: I20161014000830 |
| Provider Name | Danielle Renee Eddings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982939740 PECOS PAC ID: 4981982642 Enrollment ID: I20161031002262 |
| Provider Name | Summer L Williamson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1447400668 PECOS PAC ID: 6709169873 Enrollment ID: I20170215002155 |
| Provider Name | Susan L Zickler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336417997 PECOS PAC ID: 2567639461 Enrollment ID: I20170518001481 |
| Provider Name | Jonathan James Duncan |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1376073296 PECOS PAC ID: 5890063515 Enrollment ID: I20170621000110 |
| Provider Name | Michelle M Davis |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1578902581 PECOS PAC ID: 5092011320 Enrollment ID: I20170724000275 |
| Provider Name | Ashley Nicole Tuten |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649796350 PECOS PAC ID: 9032482591 Enrollment ID: I20170905001256 |
| Provider Name | Mariah Shiloh Schmidt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164933933 PECOS PAC ID: 0941566368 Enrollment ID: I20171117000354 |
| Provider Name | Joseph Evan Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982054854 PECOS PAC ID: 3173881661 Enrollment ID: I20171208002706 |
| Provider Name | Eric D Wolfe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366606923 PECOS PAC ID: 6800064213 Enrollment ID: I20180110000232 |
| Provider Name | Lori Torres |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376950154 PECOS PAC ID: 9830458561 Enrollment ID: I20180125001263 |
| Provider Name | Beverly Lynn Furstenberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518315886 PECOS PAC ID: 7214286517 Enrollment ID: I20180820003054 |
| Provider Name | Matthew D Dalke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861842726 PECOS PAC ID: 2668721671 Enrollment ID: I20180824001627 |
| Provider Name | Laura Windsor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801388160 PECOS PAC ID: 3577812361 Enrollment ID: I20180828002828 |
| Provider Name | Meleah Ann Crockett Morales |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1215315320 PECOS PAC ID: 6002121142 Enrollment ID: I20180829003435 |
| Provider Name | Amanda C Derham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477049930 PECOS PAC ID: 4183974777 Enrollment ID: I20180830003761 |
| Provider Name | Shay Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063999464 PECOS PAC ID: 4587914098 Enrollment ID: I20180904002806 |
| Provider Name | Lloyd D Wagner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1124161872 PECOS PAC ID: 3870517923 Enrollment ID: I20180926001717 |
| Provider Name | David Owens |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1932284833 PECOS PAC ID: 4284546987 Enrollment ID: I20180926001966 |
| Provider Name | Anthony J Alexander |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831676287 PECOS PAC ID: 4486906369 Enrollment ID: I20181003002105 |
| Provider Name | Apta Errabelli |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518303585 PECOS PAC ID: 8123315165 Enrollment ID: I20181015002598 |
| Provider Name | Radames Martinez |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1295725158 PECOS PAC ID: 0840249017 Enrollment ID: I20181019001700 |
| Provider Name | Kindra L Hale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144782020 PECOS PAC ID: 5890037402 Enrollment ID: I20190501001848 |
| Provider Name | Scott Dooley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598165565 PECOS PAC ID: 0648512939 Enrollment ID: I20190507002858 |
| Provider Name | Shelly Kahler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194193870 PECOS PAC ID: 4082947874 Enrollment ID: I20190611000444 |
| Provider Name | Kevin Daniel White |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1548656630 PECOS PAC ID: 8729331970 Enrollment ID: I20190619003702 |
| Provider Name | Mary J Nelson |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1497218911 PECOS PAC ID: 6608100649 Enrollment ID: I20190626000400 |
| Provider Name | Alyssa Easter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265882120 PECOS PAC ID: 4789919945 Enrollment ID: I20190710001064 |
| Provider Name | Nicholas J Moore |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1225695703 PECOS PAC ID: 2264768142 Enrollment ID: I20190730004075 |
| Provider Name | Brittney R Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720516396 PECOS PAC ID: 3375875149 Enrollment ID: I20191028001912 |
| Provider Name | Amber L Perkins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801361282 PECOS PAC ID: 0547592313 Enrollment ID: I20191028001944 |
| Provider Name | Aaron B Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417519679 PECOS PAC ID: 8628400439 Enrollment ID: I20191118000282 |
| Provider Name | Chelsea Ann Houser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588298228 PECOS PAC ID: 8729417894 Enrollment ID: I20200413000219 |
| Provider Name | Linsey Eckles |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1104458207 PECOS PAC ID: 6305277278 Enrollment ID: I20200508000731 |
| Provider Name | Michonne Danielle Parker |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1225530124 PECOS PAC ID: 6406278829 Enrollment ID: I20200611003312 |
| Provider Name | Rachel Sarah Corbin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174053532 PECOS PAC ID: 1658793609 Enrollment ID: I20200619000736 |
| Provider Name | Taylor Russel Short |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1235751652 PECOS PAC ID: 3870916372 Enrollment ID: I20200630002498 |
| Provider Name | Libbiana Rae Jones |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1184098014 PECOS PAC ID: 9931522497 Enrollment ID: I20200701000764 |
| Provider Name | Marc D Carrigan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225295223 PECOS PAC ID: 1951456623 Enrollment ID: I20200930000670 |
| Provider Name | Mylhan Ih Myers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639699747 PECOS PAC ID: 5890067441 Enrollment ID: I20201001000867 |
| Provider Name | Kortney Burton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689201147 PECOS PAC ID: 6608296595 Enrollment ID: I20201014002639 |
| Provider Name | Amanda Kennedy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336779305 PECOS PAC ID: 0244668135 Enrollment ID: I20201209002330 |
| Provider Name | Matthew Cox |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407252216 PECOS PAC ID: 9436562360 Enrollment ID: I20210113001472 |
| Provider Name | Brian C Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790377075 PECOS PAC ID: 6608281746 Enrollment ID: I20210223000733 |
| Provider Name | Christina Barrett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457942542 PECOS PAC ID: 5496161283 Enrollment ID: I20210302001962 |
| Provider Name | Kylie Hammerschmidt |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1558955203 PECOS PAC ID: 4183030067 Enrollment ID: I20210302003052 |
| Provider Name | Megan Quella |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194356535 PECOS PAC ID: 4981033933 Enrollment ID: I20210312000508 |
| Provider Name | Mandie Shannon Nelson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467931410 PECOS PAC ID: 4183023427 Enrollment ID: I20210519000416 |
| Provider Name | Hailey Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013591478 PECOS PAC ID: 1951700996 Enrollment ID: I20210525001848 |
| Provider Name | Hallie Casteel |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1043845993 PECOS PAC ID: 1355740192 Enrollment ID: I20210526003109 |
| Provider Name | Megan Hammer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538743273 PECOS PAC ID: 6204235021 Enrollment ID: I20210527003004 |
| Provider Name | Matthew Freihofer |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1104495308 PECOS PAC ID: 2062813991 Enrollment ID: I20210629001520 |
| Provider Name | Sarah Beth Jackson |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1316576523 PECOS PAC ID: 7810398765 Enrollment ID: I20210629002204 |
| Provider Name | Jean Oelschlager |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518989417 PECOS PAC ID: 6204915077 Enrollment ID: I20210630001661 |
| Provider Name | Derringer Fenton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386211308 PECOS PAC ID: 6002218203 Enrollment ID: I20210712000047 |
| Provider Name | Courtney Nicole Chance |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942891007 PECOS PAC ID: 0143622217 Enrollment ID: I20210712003365 |
| Provider Name | Kayla Cook |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1679145312 PECOS PAC ID: 5092118794 Enrollment ID: I20210719001705 |
| Provider Name | Courtney Kinney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427723428 PECOS PAC ID: 9931505898 Enrollment ID: I20210901002544 |
| Provider Name | Brittany Nicole Dahlager |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487283990 PECOS PAC ID: 4688071319 Enrollment ID: I20210923000993 |
| Provider Name | Elizabeth Dodd |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1538301155 PECOS PAC ID: 5395992788 Enrollment ID: I20210929002928 |
| Provider Name | Michael Munn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720612641 PECOS PAC ID: 7113357096 Enrollment ID: I20211101003020 |
| Provider Name | Noelia James |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1659867075 PECOS PAC ID: 8921491176 Enrollment ID: I20220210001355 |
| Provider Name | Jamie Lynn Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134870173 PECOS PAC ID: 9234516279 Enrollment ID: I20220513000629 |
| Provider Name | Rebecca Ruth Alumbaugh |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1053988634 PECOS PAC ID: 7719364629 Enrollment ID: I20220516001170 |
| Provider Name | Suzanna M Thorne |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1780328724 PECOS PAC ID: 8628455656 Enrollment ID: I20220603001287 |
| Provider Name | Chelsie Morgan Greenlee |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1174252019 PECOS PAC ID: 0840670576 Enrollment ID: I20220712000794 |
| Provider Name | Meagan Hansen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801535836 PECOS PAC ID: 0244612695 Enrollment ID: I20220801002434 |
| Provider Name | Bryant Zollinger Loosle |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1629572631 PECOS PAC ID: 1850648213 Enrollment ID: I20220812001753 |
| Provider Name | Margaret Elizabeth Rogers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497315527 PECOS PAC ID: 5395121446 Enrollment ID: I20220927003952 |
| Provider Name | Brittany Joy Lanham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407588551 PECOS PAC ID: 3173991056 Enrollment ID: I20221128000507 |
| Provider Name | Tiffany D Joseph |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437865599 PECOS PAC ID: 2769854959 Enrollment ID: I20230216002014 |
| Provider Name | Jedediah P Reece |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1295116333 PECOS PAC ID: 1759670524 Enrollment ID: I20230530000390 |
| Provider Name | Siri K Erickson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437771912 PECOS PAC ID: 4981029782 Enrollment ID: I20230714001675 |
| Provider Name | Briana N Beasley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609655158 PECOS PAC ID: 6204280159 Enrollment ID: I20230926001894 |
| Provider Name | Lindsi R Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871696963 PECOS PAC ID: 6406028216 Enrollment ID: I20231103001425 |
| Provider Name | Andrew R Dilisio |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760164396 PECOS PAC ID: 4587013198 Enrollment ID: I20231207003629 |
| Provider Name | Vanessa Lynne Irons |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891124962 PECOS PAC ID: 1052761657 Enrollment ID: I20231222000455 |
| Provider Name | Ryan Richard Clements |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1992437842 PECOS PAC ID: 5890145031 Enrollment ID: I20231229001219 |
| Provider Name | Nicole Collier |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215401088 PECOS PAC ID: 9335530138 Enrollment ID: I20240113000230 |
| Provider Name | Blanca E Medellin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972373637 PECOS PAC ID: 8729431861 Enrollment ID: I20240125001260 |
| Provider Name | Ashlen N Hole |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1679323901 PECOS PAC ID: 5991144370 Enrollment ID: I20240418000315 |
| Provider Name | Allyssa Myers |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1215439682 PECOS PAC ID: 4880033265 Enrollment ID: I20240418000390 |
| Provider Name | Sharyn Salkil |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023860855 PECOS PAC ID: 0345680377 Enrollment ID: I20240424002833 |
| Provider Name | Jewelia Ann Bennett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699913988 PECOS PAC ID: 9234570177 Enrollment ID: I20240509002685 |
| Provider Name | Devan L Martin |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1962038836 PECOS PAC ID: 5890137616 Enrollment ID: I20240524002198 |
James M. Carmichael, Dc Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3108 S Fremont Ave, Springfield, MO 65804 Phone: 417-886-4910 Fax: 417-886-4910 | |
Cox Senior Health Center South Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3525 S National Ave, #307, Springfield, MO 65807 Phone: 417-269-9220 Fax: 417-269-9229 | |
The Diagnostic Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3800 S National Ave, #600, Springfield, MO 65807 Phone: 417-269-1499 Fax: 417-269-1459 | |
Cox Senior Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1423 N Jefferson Ave, #k-100, Springfield, MO 65802 Phone: 417-269-3915 Fax: 417-269-3913 | |
Mercy Clinic Hospitalists Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1235 E Cherokee St, Springfield, MO 65804 Phone: 417-820-2600 Fax: 417-820-2100 | |
Elfindale Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1429 W Sunshine St, Springfield, MO 65807 Phone: 417-269-2240 Fax: 417-269-2245 | |
Jordan Valley Community Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1720 W Grand St Ste B, Springfield, MO 65802 Phone: 417-831-0150 Fax: 417-831-0155 |