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2505 Mission Dr Suite 310 Jefferson City MO 65109-9508 | |
| (573) 681-3751 | |
| (573) 681-3624 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2505 Mission Dr, Jefferson City, Missouri |
| Authorized Official Name and Position | Garrick Elliott Mueller (CFO) |
| Authorized Official Contact | 4052807582 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1027 Jefferson City MO 65102-1027 Ph: (573) 681-3767 | 2505 Mission Dr Suite 310 Jefferson City MO 65109-9508 Ph: (573) 681-3751 |
| NPI Number | 1649217837 |
|---|---|
| Provider Enumeration Date | 05/31/2006 |
| Last Update Date | 09/15/2020 |
| Medicare PECOS PAC ID | 8921917352 |
|---|---|
| Medicare Enrollment ID | O20070213000635 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649217837 | NPI | - | NPPES |
| 504456807 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | James F Tritz |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1447230131 PECOS PAC ID: 4789664947 Enrollment ID: I20040720001354 |
| Provider Name | John G Adams |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1710981444 PECOS PAC ID: 3971563198 Enrollment ID: I20041013000037 |
| Provider Name | Andrew L Karanas |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1518997394 PECOS PAC ID: 9931126927 Enrollment ID: I20070510000400 |
| Provider Name | Jeffrey S Sanders |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1407843139 PECOS PAC ID: 4385688340 Enrollment ID: I20080703000020 |
| Provider Name | William L Schlegel |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1487640223 PECOS PAC ID: 3274623624 Enrollment ID: I20080703000029 |
| Provider Name | Veeral Bhoot |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1598982167 PECOS PAC ID: 0345227898 Enrollment ID: I20080812000187 |
| Provider Name | Mohammad Jarbou |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396830915 PECOS PAC ID: 4385703578 Enrollment ID: I20081103000378 |
| Provider Name | Patrick J Morello |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1194760041 PECOS PAC ID: 9739251919 Enrollment ID: I20090109000577 |
| Provider Name | Brian L Johnson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790781896 PECOS PAC ID: 1153317722 Enrollment ID: I20090210000157 |
| Provider Name | Brian D Kleiber |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1235331570 PECOS PAC ID: 4284786146 Enrollment ID: I20090723000583 |
| Provider Name | Joseph A Corrado |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1659376655 PECOS PAC ID: 2062552300 Enrollment ID: I20091217000677 |
| Provider Name | Byron B Tarbox |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1629061205 PECOS PAC ID: 5597853044 Enrollment ID: I20100527000357 |
| Provider Name | Jeff A Lehmen |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1326134925 PECOS PAC ID: 4183748080 Enrollment ID: I20110810000200 |
| Provider Name | Jay T Bridgeman |
|---|---|
| Provider Type | Practitioner - Hand Surgery |
| Provider Identifiers | NPI Number: 1720200918 PECOS PAC ID: 1254407174 Enrollment ID: I20130312000099 |
| Provider Name | Walter C Coats |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1316122245 PECOS PAC ID: 0941440911 Enrollment ID: I20130716000286 |
| Provider Name | Housam E Soukieh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568422673 PECOS PAC ID: 1254482631 Enrollment ID: I20140904002142 |
| Provider Name | Michael Wesley Robertson |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1326200759 PECOS PAC ID: 8123268695 Enrollment ID: I20140911000824 |
| Provider Name | Joshua Hamann |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1881709715 PECOS PAC ID: 7810146503 Enrollment ID: I20160229000491 |
| Provider Name | Khalid I Waliullah |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1275829723 PECOS PAC ID: 6406090786 Enrollment ID: I20160818001299 |
| Provider Name | Kyle Bruns |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1639411366 PECOS PAC ID: 8022310598 Enrollment ID: I20170616001598 |
| Provider Name | Devin S Kennedy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508270307 PECOS PAC ID: 7214153527 Enrollment ID: I20180801003413 |
| Provider Name | Ahmad Abou Leila |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1861741126 PECOS PAC ID: 4183993546 Enrollment ID: I20190417000333 |
| Provider Name | Neeraj Singh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194160457 PECOS PAC ID: 6709136443 Enrollment ID: I20200709003523 |
| Provider Name | Rajiv Narula |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1982959979 PECOS PAC ID: 6709147689 Enrollment ID: I20200728002017 |
| Provider Name | Ruchir Shah |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1396033437 PECOS PAC ID: 1557656501 Enrollment ID: I20200806000541 |
| Provider Name | Michael Chen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558757757 PECOS PAC ID: 9335424449 Enrollment ID: I20200825001106 |
| Provider Name | Michelle L Ruppel |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1831457886 PECOS PAC ID: 2062831464 Enrollment ID: I20201005001697 |
| Provider Name | Troy Joseph Loethen |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1457731234 PECOS PAC ID: 2668784000 Enrollment ID: I20210830000248 |
| Provider Name | Ashlee Marie Hedrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538815386 PECOS PAC ID: 6507251980 Enrollment ID: I20220322001216 |
| Provider Name | Melanie Winningham |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1588954788 PECOS PAC ID: 9335434752 Enrollment ID: I20220519001444 |
| Provider Name | Samuel Franklin Thompson |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1164878237 PECOS PAC ID: 6709170772 Enrollment ID: I20220608001142 |
| Provider Name | Zachary Luebbering |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1346697455 PECOS PAC ID: 5597035022 Enrollment ID: I20220730000068 |
| Provider Name | Sostanie Enoru |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1740671254 PECOS PAC ID: 9537404561 Enrollment ID: I20220823003529 |
| Provider Name | Nathaniel Prevette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639552060 PECOS PAC ID: 3274917125 Enrollment ID: I20220826001862 |
| Provider Name | Thomas Ryan |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1508852062 PECOS PAC ID: 6608810189 Enrollment ID: I20230209001603 |
| Provider Name | Alexander Carey Wendling |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1114456597 PECOS PAC ID: 0941571004 Enrollment ID: I20230720001251 |
| Provider Name | Jacob R Hayden |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1871022954 PECOS PAC ID: 2365712882 Enrollment ID: I20230726003141 |
| Provider Name | Laura Kay Sicht |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205612199 PECOS PAC ID: 5496109563 Enrollment ID: I20230922001255 |
| Provider Name | Katherine J Sartorius |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1447020367 PECOS PAC ID: 2365885225 Enrollment ID: I20240213002269 |
| Provider Name | Steven Arbogast |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1962615377 PECOS PAC ID: 3375697774 Enrollment ID: I20240422002924 |
| Provider Name | Pranusha Pinna |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1861983660 PECOS PAC ID: 6406105154 Enrollment ID: I20240423004069 |
| Provider Name | Ann Collier |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1487898458 PECOS PAC ID: 0042442915 Enrollment ID: I20240504000214 |
| Provider Name | Tori Lafleur |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1447639422 PECOS PAC ID: 7719212927 Enrollment ID: I20240508000819 |
| Provider Name | Steven Tversky |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1356683874 PECOS PAC ID: 1658633664 Enrollment ID: I20240517000841 |
| Provider Name | Ali Adela Payan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508455635 PECOS PAC ID: 0941696728 Enrollment ID: I20240520000254 |
| Provider Name | Kathryn Hamblen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740615145 PECOS PAC ID: 4183855612 Enrollment ID: I20240530000381 |
| Provider Name | Marion A Fossum |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1356875736 PECOS PAC ID: 0244772507 Enrollment ID: I20240603001900 |
| Provider Name | Joseph Niland |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1265964670 PECOS PAC ID: 2365803632 Enrollment ID: I20240625002532 |
| Provider Name | Tyler L Alderson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639521750 PECOS PAC ID: 4082908686 Enrollment ID: I20240828003530 |
Spine Midwest, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 200 Saint Marys Medical Plz, Suite 301, Jefferson City, MO 65101 Phone: 573-634-4212 | |
Family Medicine Of Jefferson City, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1616 Southridge Dr, Suite #203, Jefferson City, MO 65109 Phone: 573-659-7300 Fax: 573-636-0555 | |
Innovative Medical Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3218 W Edgewood Dr, Ste 500, Jefferson City, MO 65109 Phone: 949-696-6157 | |
Jefferson City Medical Group, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1735 Elm Ct, Jefferson City, MO 65101 Phone: 573-634-4878 |