SOUTHEAST MISSOURI RESIDENTIAL SERVICES-POPLAR BLUFF PROF GRP
NPI 1740560580
Family Medicine in Poplar Bluff, MO
About Southeast Missouri Residential Services-poplar Bluff Prof Grp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTHEAST MISSOURI RESIDENTIAL SERVICES-POPLAR BLUFF PROF GRP (NPI 1740560580) is a healthcare organization registered as a family medicine in Poplar Bluff, Missouri and active in the NPI registry since August 2011. The organization lists Molly Jane Boeckmann, Director Of Administrative Services, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Southeast Missouri Residential Services-poplar Bluff Prof Grp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
39Medicare enrollment records show 39 clinicians reassign Medicare billing to Southeast Missouri Residential Services-Poplar Bluff Prof Grp, which bills Medicare for the services they deliver. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 7
Nearest to this location (20)
See all 39Fulton, MO 65251
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is State Of Missouri's NPI number?
The NPI number for State Of Missouri is 1740560580. It was assigned to this organization in the NPPES registry on August 25, 2011. The provider is doing business as Southeast Missouri Residential Services-Poplar Bluff Prof Grp.
Where is State Of Missouri located?
State Of Missouri is located at 2351 Kanell Blvd, Poplar Bluff, MO 63901. The listed phone number is (573) 840-9370.
What is State Of Missouri's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is State Of Missouri enrolled in Medicare?
Yes. State Of Missouri is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through State Of Missouri?
According to the CMS Revalidation Reassignment List (October 2026 release), 39 clinicians in 7 Medicare specialties reassign their Medicare billing to State Of Missouri. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Psychiatry (20), Nurse Practitioner (9) and Clinical Psychologist (6). Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for State Of Missouri was last updated on October 15, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Southeast Missouri Residential Services-Poplar Bluff Prof Grp · NPI 1740560580
Family Medicine organization in Poplar Bluff, Missouri. Organization record, active in the CMS NPPES registry since August 25, 2011.
## Identity
- **NPI:** 1740560580 (Entity type: Organization)
- **Enumerated:** August 25, 2011
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Legal business name:** State Of Missouri
- **Organization subpart:** Yes (part of State Of Missouri)
- **Authorized official:** Molly Boeckmann, DIRECTOR OF ADMINISTRATIVE SERVICES
## Practice location
- **Address:** 2351 KANELL BLVD, Poplar Bluff, MO 63901-4035
- **Phone:** (573) 840-9370 · **Fax:** (573) 840-9373
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 39 clinicians in 7 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Psychiatry (20), Nurse Practitioner (9), Clinical Psychologist (6); [full list](https://npiprofile.com/npi/1740560580/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 15, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1740560580) · Data from the CMS NPPES public registry.