PCRMC MEDICAL GROUP, INC
Complete NPI Record 1124237227
Clinic/Center in Rolla, MO
Active since May 22, 2007
Complete NPI Dataset
This page contains the complete raw NPPES record for Pcrmc Medical Group, Inc (NPI 1124237227), a clinic/center organization in Rolla, MO. All 37 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1124237227 Field 1/37
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/37
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/37
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: PCRMC MEDICAL GROUP, INC Field 4/37
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: Not available Field 5/37
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 6 Field 6/37
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: PO BOX 579 Field 7/37
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: ROLLA Field 8/37
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: MO Field 9/37
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 654020579 Field 10/37
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/37
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 5734262182 Field 12/37
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 5734265341 Field 13/37
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 1050 W 10TH ST Field 14/37
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: ROLLA Field 15/37
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: MO Field 16/37
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 654012905 Field 17/37
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/37
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 5733649000 Field 19/37
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 5734583952 Field 20/37
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: COOK Field 23/37
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: JANA Field 24/37
- The first name of the authorized official.
- Authorized Official Middle Name: M Field 25/37
- The middle name of the authorized official.
- Authorized Official Title or Position: VP, CHIEF FINANCIAL OFFICER Field 26/37
- The title or position of the authorized official.
- Authorized Official Telephone Number: 5734587916 Field 27/37
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 261Q00000X Field 28/37
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 29/37
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Other Provider Identifier 1: 591072301 Field 30/37
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 1: 05 Field 31/37
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 1: MO Field 32/37
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Other Provider Identifier 2: 507013605 Field 33/37
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 2: 05 Field 34/37
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 2: MO Field 35/37
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Is Organization Subpart: N Field 36/37
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
Other Organization Names 1
Additional business and trade names this provider has on file with the NPPES registry.
Phelps Health Medical Group Rolla Doing Business As
Name 1/1Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Secondary Practice Locations 11
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
1000 W 10th St
Location 1/11Rolla, MO 65401-2905 · Phone (573) 364-9000 · Fax (573) 426-2108
603 S Bishop Ave
Location 2/11Rolla, MO 65401-4320 · Phone (573) 426-4411 · Fax (573) 426-4403
1428 E State Hwy 72
Location 3/11Rolla, MO 65401-3988 · Phone (573) 364-1014 · Fax (573) 364-6872
35629 Highway 72
Location 4/11Salem, MO 65560-7217 · Phone (855) 406-3324 · Fax (573) 458-8363
1415 W Scenic Rivers Blvd
Location 5/11Salem, MO 65560-2840 · Phone (573) 729-5533 · Fax (573) 202-2466
1000 N Jefferson St
Location 6/11Saint James, MO 65559-1078 · Phone (573) 265-8840 · Fax (573) 202-2474
1060 W 10th St
Location 7/11Rolla, MO 65401-2905 · Phone (855) 406-3324 · Fax (573) 458-8363
600 Blues Lake Pkwy
Location 8/11Rolla, MO 65401-8022 · Phone (573) 364-8822 · Fax (573) 202-2402
1201 Hauck Dr
Location 9/11Rolla, MO 65401-4900 · Phone (573) 364-8818
1000 Gw Ln
Location 10/11Waynesville, MO 65583-2339 · Phone (573) 774-2715 · Fax (573) 202-2410
1422 S Sam Houston Blvd
Location 11/11Houston, MO 65483-2130 · Phone (573) 364-9000 · Fax (573) 426-2108
Other Provider Identifiers 2
Legacy and payer-issued identifiers reported to the NPPES registry for this provider.
591072301 Medicaid
Identifier 1/2State: MO
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
507013605 Medicaid
Identifier 2/2State: MO
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
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