FCC PRIMARY CARE CLINIC POPLAR BLUFF
NPI 1215510490
Internal Medicine in Poplar Bluff, MO
NPI Status: Active since May 04, 2021
Contact Information
3001 WARRIOR LN
POPLAR BLUFF, MO
ZIP 63901
Phone: (573) 686-1200
Fax: (573) 778-9492
- Organization
- Internal Medicine
- Accepts Insurance
- CLIA Number: 26D2164008
- CLIA Cert. Type: Rural Health Clinic
- CLIA Exp. Date: 11-27-2027
About FCC PRIMARY CARE CLINIC POPLAR BLUFF
This page provides the complete NPI Profile along with additional information for Fcc Primary Care Clinic Poplar Bluff, an internist established in Poplar Bluff, Missouri operating as a Internal Medicine. The healthcare provider is registered in the NPI registry with number 1215510490 assigned on May 2021. The practitioner's primary taxonomy code is 207R00000X. The provider is registered as an organization and their NPI record was last updated 5 years ago. Fcc Primary Care Clinic Poplar Bluff operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The provider's is doing business as Fcc Primary Care Clinic Poplar Bluff. The authorized official of this NPI record is Tracy Ellis (Cco)
- NPI
- 1215510490
- Provider Legal Name
- FCC MEDICAL CLINICS LLC
- Other Organization Name
- FCC PRIMARY CARE CLINIC POPLAR BLUFF
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 3001 WARRIOR LN POPLAR BLUFF, MO 63901
- Location Phone
- (573) 686-1200
- Location Fax
- (573) 778-9492
- Mailing Address
- PO BOX 71 KENNETT, MO 63857
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 05-04-2021
- Last Update Date
- 07-12-2021
- Code Navigator
An internist like Fcc Primary Care Clinic Poplar Bluff is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Internal Medicine
- Taxonomy Code
- 207R00000X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Choice Bronze HSA (QualChoice) - POS
- Complete Gold - PPO
- Complete Gold + Vision + Adult Dental - PPO
- Connected Silver - PPO
- Connected Silver (QualChoice) - POS
- Connected Silver (QualChoice) + Vision + Adult Dental - POS
- Connected Silver (QualChoiceLife) - PPO
- Connected Silver (QualChoiceLife) + Vision + Adult Dental - PPO
- Connected Silver + Vision + Adult Dental - PPO
- Elite Bronze - PPO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Complete Silver - EPO
- Complete Silver + Vision + Adult Dental - EPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Everyday Gold - EPO
- Everyday Gold + Vision + Adult Dental - EPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Elite Gold - EPO
- Elite Gold + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Everyday Gold - EPO
- Everyday Gold + Vision + Adult Dental - EPO
- Focused Silver - EPO
- Focused Silver + Vision + Adult Dental - EPO
- Choice Bronze HSA - EPO
- Choice Bronze HSA + Vision + Adult Dental - EPO
- Clear Gold - EPO
- Clear Gold + Vision + Adult Dental - EPO
- Complete Gold - HMO
- Complete Gold + Vision + Adult Dental - HMO
- Elite Bronze - EPO
- Elite Bronze - HMO
- Elite Bronze + Vision + Adult Dental - EPO
- Elite Bronze + Vision + Adult Dental - HMO
- Clear Gold - EPO
- Clear Gold + Vision + Adult Dental - EPO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Elite Silver - EPO
- Elite Silver + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Focused Silver - EPO
- Focused Silver + Vision + Adult Dental - EPO
- Elite Bronze - PPO
- Elite Bronze + Vision + Adult Dental - PPO
- Elite Gold - PPO
- Elite Gold + Vision + Adult Dental - PPO
- Enhanced Asthma/COPD Care Silver with $0 Drug Options - PPO
- Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental - PPO
- Enhanced Diabetes Care Silver with $0 Drug Options - PPO
- Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - PPO
- Everyday Bronze - PPO
- Everyday Bronze + Vision + Adult Dental - PPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Elite Gold - EPO
- Elite Gold + Vision + Adult Dental - EPO
- Enhanced Diabetes Care Silver with $0 Drug Options - EPO
- Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Everyday Gold - EPO
- Everyday Gold + Vision + Adult Dental - EPO
- Anthem Bronze Pathway 10150 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Bronze Pathway 6900 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Bronze Pathway 7500 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Catastrophic Pathway (+ Incentives) - EPO
- Anthem Gold Pathway 2000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Heart Healthy Bronze Pathway 4900 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Heart Healthy Silver Pathway 3100 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Silver Pathway 5350 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Silver Pathway 6000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Silver Pathway 7200 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 26D2164008
- Facility Type
- Rural Health Clinic
- Certificate Effective Date
- November 28, 2025
- Certificate Expiration Date
- November 27, 2027
- Laboratory Director
- SARFARAZ JASDANWALA
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Fcc Primary Care Clinic Poplar Bluff to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1215510490, we treat the final digit (0) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 50. The final step is to find the difference between that total and the next multiple of ten (50 - 50 = 0).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 50 is 50. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
POPLAR BLUFF, MO 63901
POPLAR BLUFF, MO 63901
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1215510490, enumerated as an "organization" on May 04, 2021.
The provider is located at 3001 WARRIOR LN POPLAR BLUFF, MO 63901 and the phone number is (573) 686-1200.
Internal Medicine with taxonomy code 207R00000X.
The provider might be accepting Accepts: Ambetter from Arkansas Health & Wellness, Ambetter. Please consult your insurance carrier or call the provider to verify.
