| Jefferson City Medical Group, P.c. | |
|
1241 W Stadium Blvd First Floor, Suite 1100 Jefferson City MO 65109 | |
| (573) 556-5747 | |
| (573) 636-9756 |
| Full Name | Jefferson City Medical Group, P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1241 W Stadium Blvd, Jefferson City, Missouri |
| Authorized Official Name and Position | Jeffrey Patrick (PRESIDENT) |
| Authorized Official Contact | 5736355264 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jefferson City Medical Group, P.c. Po Box 104240 Jefferson City MO 65110-4240 Ph: (573) 635-5264 | Jefferson City Medical Group, P.c. 1241 W Stadium Blvd First Floor, Suite 1100 Jefferson City MO 65109 Ph: (573) 556-5747 |
| NPI Number | 1336189398 |
|---|---|
| Provider Enumeration Date | 06/07/2006 |
| Last Update Date | 06/08/2023 |
| Medicare PECOS PAC ID | 1850371089 |
|---|---|
| Medicare Enrollment ID | O20040908000924 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336189398 | NPI | - | NPPES |
| CD6061 | Other | MO | MEDICARE RAILROAD |
| CC7852 | Other | MO | MEDICARE RAILROAD |
| CD6058 | Other | MO | MEDICARE RAILROAD |
| CD6059 | Other | MO | MEDICARE RAILROAD |
| CD6060 | Other | MO | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Keith E Segall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639245368 PECOS PAC ID: 9739084757 Enrollment ID: I20040331000436 |
| Provider Name | Jeffrey L Patrick |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316910904 PECOS PAC ID: 6709868821 Enrollment ID: I20040603000050 |
| Provider Name | Bradley S Sloan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780789032 PECOS PAC ID: 0143208025 Enrollment ID: I20040708000354 |
| Provider Name | Michael Snyder |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1285611095 PECOS PAC ID: 9739169954 Enrollment ID: I20040720001088 |
| Provider Name | Christopher Case |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1871552794 PECOS PAC ID: 9133109374 Enrollment ID: I20040720001280 |
| Provider Name | Allyson J Ihms |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1033174800 PECOS PAC ID: 5294709291 Enrollment ID: I20040825000290 |
| Provider Name | Stephen Sides |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1366428914 PECOS PAC ID: 4981679107 Enrollment ID: I20040831001322 |
| Provider Name | Calvin E Williams |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1326085465 PECOS PAC ID: 3577539527 Enrollment ID: I20040909001195 |
| Provider Name | Steve Carl Harper |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558334516 PECOS PAC ID: 1850298308 Enrollment ID: I20040930000183 |
| Provider Name | Darcy L Miller |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1922093608 PECOS PAC ID: 3476518713 Enrollment ID: I20041129000151 |
| Provider Name | Mark F Gortmaker |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1649244161 PECOS PAC ID: 0749239036 Enrollment ID: I20050113000393 |
| Provider Name | Philip L Rumbaoa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083686661 PECOS PAC ID: 8729039227 Enrollment ID: I20050202000164 |
| Provider Name | Teresa K Givens |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1588659684 PECOS PAC ID: 2668427683 Enrollment ID: I20050314000102 |
| Provider Name | Tamara Hopkins |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1144226465 PECOS PAC ID: 9133160286 Enrollment ID: I20050518001070 |
| Provider Name | Jason Kyle Frost |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1710944723 PECOS PAC ID: 3577509371 Enrollment ID: I20050701000393 |
| Provider Name | Jonathan M Craighead |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1346226289 PECOS PAC ID: 5395772628 Enrollment ID: I20050719000593 |
| Provider Name | Saira Babar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306822317 PECOS PAC ID: 0244260156 Enrollment ID: I20050819000183 |
| Provider Name | David L Mclaren |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1245207109 PECOS PAC ID: 2062439383 Enrollment ID: I20051026000837 |
| Provider Name | Bonnie R Smith |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073554267 PECOS PAC ID: 4284643958 Enrollment ID: I20060410000125 |
| Provider Name | William J Duke |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1629016902 PECOS PAC ID: 0446262190 Enrollment ID: I20060620000034 |
| Provider Name | William Joseph Deckert |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1801977590 PECOS PAC ID: 9234139650 Enrollment ID: I20070109000598 |
| Provider Name | Indumathi R Baskar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083634331 PECOS PAC ID: 6709842784 Enrollment ID: I20070131000146 |
| Provider Name | Jody Mcaleer |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1801868294 PECOS PAC ID: 6406875491 Enrollment ID: I20070523000130 |
| Provider Name | John D Despain |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1932196433 PECOS PAC ID: 5597768986 Enrollment ID: I20070814000590 |
| Provider Name | Justin A Malone |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1689895534 PECOS PAC ID: 6406948439 Enrollment ID: I20070822001247 |
| Provider Name | Rezwan Islam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124054556 PECOS PAC ID: 6103910369 Enrollment ID: I20070919000093 |
| Provider Name | Amber C Abeln |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720275027 PECOS PAC ID: 6608964150 Enrollment ID: I20071116000021 |
| Provider Name | April Star Cooper |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1912006958 PECOS PAC ID: 9335052042 Enrollment ID: I20071121000282 |
| Provider Name | Elaine I Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477733806 PECOS PAC ID: 4587747191 Enrollment ID: I20080205000637 |
| Provider Name | Shadi M Haddadin |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1073611919 PECOS PAC ID: 7517046865 Enrollment ID: I20080512000427 |
| Provider Name | Joseph Genovese |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336265487 PECOS PAC ID: 7012082258 Enrollment ID: I20080822000036 |
| Provider Name | Thomas Schneider |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1003875360 PECOS PAC ID: 2668548371 Enrollment ID: I20080903000631 |
| Provider Name | Joseph Wang |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1437118718 PECOS PAC ID: 9830265545 Enrollment ID: I20080903000639 |
| Provider Name | Alan T Rauba |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1568442267 PECOS PAC ID: 7810063526 Enrollment ID: I20080903000660 |
| Provider Name | Robyn M Mccullem |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1598749467 PECOS PAC ID: 6103837182 Enrollment ID: I20080917000598 |
| Provider Name | Jaime L Walker |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1396991071 PECOS PAC ID: 4587732722 Enrollment ID: I20081001000417 |
| Provider Name | Stephanie K Hose |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1497735195 PECOS PAC ID: 8022177948 Enrollment ID: I20081107000073 |
| Provider Name | Krishna K Mettu |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1508977257 PECOS PAC ID: 5092860783 Enrollment ID: I20090901000672 |
| Provider Name | Simin Ovais |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306957691 PECOS PAC ID: 5193870574 Enrollment ID: I20090909000108 |
| Provider Name | Thomas D Robbins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508836115 PECOS PAC ID: 4183769508 Enrollment ID: I20100309000601 |
| Provider Name | Michael Steenbergen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013997337 PECOS PAC ID: 2961582176 Enrollment ID: I20100309000613 |
| Provider Name | Susan R Wolfe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609072248 PECOS PAC ID: 2466580667 Enrollment ID: I20100510000101 |
| Provider Name | George Carr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528032661 PECOS PAC ID: 0840383006 Enrollment ID: I20100520000029 |
| Provider Name | Jack M Dodson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821069345 PECOS PAC ID: 0446389092 Enrollment ID: I20100520000447 |
| Provider Name | Steve T Linsenbardt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972589711 PECOS PAC ID: 7517096183 Enrollment ID: I20100520000611 |
| Provider Name | Reese E Thompson |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1922071992 PECOS PAC ID: 2769527928 Enrollment ID: I20100520000623 |
| Provider Name | Nina M Kiekhaefer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174509087 PECOS PAC ID: 3678602240 Enrollment ID: I20100520000658 |
| Provider Name | Elliott D Roberts |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1013997782 PECOS PAC ID: 0840329306 Enrollment ID: I20100521000846 |
| Provider Name | Kelly Mangold |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1477876803 PECOS PAC ID: 2466582424 Enrollment ID: I20100617000666 |
| Provider Name | Judy A Wienke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013988633 PECOS PAC ID: 3678605771 Enrollment ID: I20100723000819 |
| Provider Name | Myles B Goble |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1013028745 PECOS PAC ID: 3274666086 Enrollment ID: I20100730000506 |
| Provider Name | Sara M Echelmeyer |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1346220746 PECOS PAC ID: 2961432273 Enrollment ID: I20100810000324 |
| Provider Name | Brandon Lee Jenson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1598078677 PECOS PAC ID: 4981738689 Enrollment ID: I20100817000960 |
| Provider Name | Michael J Simmons |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1366554586 PECOS PAC ID: 3678507118 Enrollment ID: I20100818000331 |
| Provider Name | Brandi M Nichols |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1578656674 PECOS PAC ID: 3971637240 Enrollment ID: I20100823000708 |
| Provider Name | Zebulon Edward Thomeczek |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1033420724 PECOS PAC ID: 2769507748 Enrollment ID: I20100914000985 |
| Provider Name | Patrick Sporleder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922099506 PECOS PAC ID: 6406992445 Enrollment ID: I20101011000658 |
| Provider Name | Janet I Samuels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134188303 PECOS PAC ID: 4587857081 Enrollment ID: I20101015001095 |
| Provider Name | Jason A Dundulis |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1548421183 PECOS PAC ID: 1456529759 Enrollment ID: I20110712000201 |
| Provider Name | Marcus J Wade |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861583544 PECOS PAC ID: 5395898712 Enrollment ID: I20110801000356 |
| Provider Name | Amanda T Rodemann |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1265639603 PECOS PAC ID: 3476722182 Enrollment ID: I20110815000880 |
| Provider Name | James M Koch |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1164625794 PECOS PAC ID: 5193994796 Enrollment ID: I20110817000279 |
| Provider Name | Joyce Wilson |
|---|---|
| Provider Type | Practitioner - Hand Surgery |
| Provider Identifiers | NPI Number: 1093925703 PECOS PAC ID: 1052444890 Enrollment ID: I20110824000532 |
| Provider Name | Jodi A Berendzen |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1356509871 PECOS PAC ID: 7810169133 Enrollment ID: I20111011000253 |
| Provider Name | John William Middleton |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1265442974 PECOS PAC ID: 9830365048 Enrollment ID: I20120110000076 |
| Provider Name | Robert O Meyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669775771 PECOS PAC ID: 2264611045 Enrollment ID: I20120203000603 |
| Provider Name | Dwight M Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952675381 PECOS PAC ID: 5294997458 Enrollment ID: I20120503000699 |
| Provider Name | Alfred D Johnson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396900510 PECOS PAC ID: 3870741911 Enrollment ID: I20120914000762 |
| Provider Name | Matthew Ragsdell |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1629196811 PECOS PAC ID: 9830258649 Enrollment ID: I20121026000140 |
| Provider Name | Austyn Patrice Belle Isle |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1417210949 PECOS PAC ID: 6204087067 Enrollment ID: I20121105000233 |
| Provider Name | Joseph M Meystrik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982943502 PECOS PAC ID: 6709022981 Enrollment ID: I20130412000241 |
| Provider Name | Jennifer Desy |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1689927857 PECOS PAC ID: 8628216231 Enrollment ID: I20130521000129 |
| Provider Name | Joshua M Britton |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1336489806 PECOS PAC ID: 3971737800 Enrollment ID: I20131009000588 |
| Provider Name | Julie Roushdi |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1881027027 PECOS PAC ID: 8628203106 Enrollment ID: I20131109000627 |
| Provider Name | Meghan Marie Lees |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1134543614 PECOS PAC ID: 0042441065 Enrollment ID: I20140314001576 |
| Provider Name | Leah D Bolten |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1346667706 PECOS PAC ID: 6800013822 Enrollment ID: I20140814000546 |
| Provider Name | Imran Ashraf |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1659683498 PECOS PAC ID: 0648414169 Enrollment ID: I20150403000201 |
| Provider Name | Clinton L Harris |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1417940321 PECOS PAC ID: 4486695129 Enrollment ID: I20150508001859 |
| Provider Name | Angela R Hunt |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1538480587 PECOS PAC ID: 2264566298 Enrollment ID: I20150608002169 |
| Provider Name | Rachel Jackman |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1174946610 PECOS PAC ID: 7012229958 Enrollment ID: I20150706002381 |
| Provider Name | Ashley Lepage |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790177236 PECOS PAC ID: 2668789140 Enrollment ID: I20150916000571 |
| Provider Name | Amanda L Peters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093265266 PECOS PAC ID: 7315226230 Enrollment ID: I20161117000924 |
| Provider Name | Mary Patricia Bunch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396296331 PECOS PAC ID: 2961783014 Enrollment ID: I20170103001065 |
| Provider Name | James C Lin |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1801982608 PECOS PAC ID: 4183702061 Enrollment ID: I20170502001124 |
| Provider Name | Tanner W Coleman |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1407260425 PECOS PAC ID: 5991005993 Enrollment ID: I20170607002888 |
| Provider Name | Brandy N Glascock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578884995 PECOS PAC ID: 9133354558 Enrollment ID: I20170717000129 |
| Provider Name | Melissa Maria Grcic-jacobelli |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1023094372 PECOS PAC ID: 0547202053 Enrollment ID: I20171031000211 |
| Provider Name | Nicole Msn, Fnp-c Mistler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184144156 PECOS PAC ID: 0941568232 Enrollment ID: I20171214000578 |
| Provider Name | Annette Marie Holt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659888428 PECOS PAC ID: 3678832375 Enrollment ID: I20180125000231 |
| Provider Name | Steven J Dalbec |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1043203094 PECOS PAC ID: 2668664996 Enrollment ID: I20180426001585 |
| Provider Name | Caleb M Steffen |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1275844771 PECOS PAC ID: 8527281435 Enrollment ID: I20180517000270 |
| Provider Name | Alisha M Hinds |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1578825485 PECOS PAC ID: 9133353246 Enrollment ID: I20180608001590 |
| Provider Name | Benjamin R Cook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679998975 PECOS PAC ID: 4486913472 Enrollment ID: I20180611002584 |
| Provider Name | Ryan M Shaffer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679053813 PECOS PAC ID: 0244584027 Enrollment ID: I20181114000846 |
| Provider Name | Megan Elaine Hilderbrand |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1013468446 PECOS PAC ID: 7113296310 Enrollment ID: I20181205003140 |
| Provider Name | Rachel Marie Rucker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396196549 PECOS PAC ID: 7214222074 Enrollment ID: I20190719001549 |
| Provider Name | Joshua Delozier |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1598320558 PECOS PAC ID: 8426384876 Enrollment ID: I20190724000096 |
| Provider Name | Crystelle Wiona Canuto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063076313 PECOS PAC ID: 9234465683 Enrollment ID: I20190724000138 |
| Provider Name | Kimberly L Peacock |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1942347919 PECOS PAC ID: 3274616032 Enrollment ID: I20190828003085 |
| Provider Name | Megan Elizabeth Gauthier |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1669899647 PECOS PAC ID: 1658597455 Enrollment ID: I20190907000195 |
| Provider Name | Kaitlin Marie Saucier |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922457738 PECOS PAC ID: 1456643162 Enrollment ID: I20190910001070 |
| Provider Name | Cortny Osie-ann Vandergrift |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215570585 PECOS PAC ID: 4183056393 Enrollment ID: I20191108001459 |
| Provider Name | Corey E Menius |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1134514474 PECOS PAC ID: 2961794623 Enrollment ID: I20200218001444 |
| Provider Name | Cory Lynn Myren |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1730537630 PECOS PAC ID: 1355634262 Enrollment ID: I20200515001223 |
| Provider Name | Belinda S Harper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265912786 PECOS PAC ID: 7517389026 Enrollment ID: I20200629002600 |
| Provider Name | Taylor Donahue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154937449 PECOS PAC ID: 3779996376 Enrollment ID: I20201228001172 |
| Provider Name | Laura Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508453671 PECOS PAC ID: 2466866397 Enrollment ID: I20210203002954 |
| Provider Name | Edward Jim Vredenburgh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841741030 PECOS PAC ID: 6305252982 Enrollment ID: I20210305000484 |
| Provider Name | John Steven Waschak |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1922102045 PECOS PAC ID: 3072596782 Enrollment ID: I20210514001714 |
| Provider Name | Sarah Larraine Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912571282 PECOS PAC ID: 5395145205 Enrollment ID: I20210615001669 |
| Provider Name | Taylor Goldammer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1780170712 PECOS PAC ID: 3577816263 Enrollment ID: I20210802002019 |
| Provider Name | Shinal Mayank Patel |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1871956698 PECOS PAC ID: 3375830151 Enrollment ID: I20210831002828 |
| Provider Name | Mckenzie Hamacher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962174375 PECOS PAC ID: 8325436751 Enrollment ID: I20211103002783 |
| Provider Name | Jana Lynn Holsman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679239719 PECOS PAC ID: 1658761630 Enrollment ID: I20211206002349 |
| Provider Name | Edina Ademovic |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1992388391 PECOS PAC ID: 2365832177 Enrollment ID: I20211210001051 |
| Provider Name | Mary J Drenon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790434413 PECOS PAC ID: 1557749298 Enrollment ID: I20220608000886 |
| Provider Name | Cory R Brune |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1376049510 PECOS PAC ID: 5496002859 Enrollment ID: I20220608001154 |
| Provider Name | Sarah E Heckemeyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598497489 PECOS PAC ID: 6204217334 Enrollment ID: I20220720001219 |
| Provider Name | Kevin Michel Middlemist |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1740641851 PECOS PAC ID: 8527440445 Enrollment ID: I20220809000675 |
| Provider Name | Chantel Marie Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457075889 PECOS PAC ID: 9133595788 Enrollment ID: I20221021002411 |
| Provider Name | Briana Kathleen Kile |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447961511 PECOS PAC ID: 8123497088 Enrollment ID: I20221215001792 |
| Provider Name | Wen Hsin Ku |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013679489 PECOS PAC ID: 9335509868 Enrollment ID: I20230717000634 |
| Provider Name | Janet L Barnes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669174777 PECOS PAC ID: 3375986656 Enrollment ID: I20240205001242 |
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 | |
Capital Region Corporate Health Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1500 Southwest Blvd, Ste C, Jefferson City, MO 65109 Phone: 573-632-5786 Fax: 573-632-5833 | |
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 | |
Ssm Health Wound Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2505 Mission Dr, Suite 210, Jefferson City, MO 65109 Phone: 573-681-3000 Fax: 573-659-2503 | |
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 | |
Capital Region Physicians - Family Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 420 E High St, Jefferson City, MO 65101 Phone: 573-635-0916 Fax: 573-635-8812 | |
Capital Region Physicians - Southwest Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1500 Southwest Blvd, Ste D, Jefferson City, MO 65109 Phone: 573-632-5780 Fax: 573-632-5833 |