CAPITAL REGION MEDICAL CENTER (NPI# 1679825244) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679825244 |
| Entity Type | Organization |
| Organization Name | CAPITAL REGION MEDICAL CENTER |
| Other Organization Name | RADIANCE MEDICAL SPA AND VEIN CARE |
| Practice Address |
1432 Southwest Blvd Jefferson City MO 65109-2444 |
| Practice Telephone | 5736325580 |
| Mailing Telephone | 5736325580 |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2013-12-19 |
| Authorized Official Name | TOM LUEBBERING (VICE PRESIDENT OF FINANCE) |
| Authorized Official Telephone | 5736325102 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085B0100X |
Radiology Specialization: Body Imaging |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Radiance Medical Spa and Vein Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821228388 | Capital Region Medical Center | Internal Medicine | 999 Diamond Rdg, Suite 201, Jefferson City, MO 65109-6920 | 2009-07-19 |
| 1679701296 | Capital Region Medical Center | Family Medicine | 3308 W Edgewood, Suite B, Jefferson City, MO 65109 | 2009-06-23 |
| 1285810093 | Capital Region Medical Center | Family Medicine | 309 N. Main Street, Chamois, MO 65024 | 2008-01-11 |
| 1215057542 | Capital Region Medical Center | Physical Therapist | 1015 Moreau Dr, Jefferson City, MO 65101-3518 | 2007-03-30 |
| 1629031018 | Capital Region Medical Center | Clinic/Center | 1014 Madison St, Jefferson City, MO 65102-3458 | 2006-04-08 |
| 1134188741 | Capital Region Medical Center | Clinic/Center | 3536 Kuhne Road, Owensville, MO 65066 | 2006-03-22 |
| 1215906433 | Capital Region Medical Center | Family Medicine | 2nd Street and Oak, Stover, MO 65078 | 2006-03-17 |
| 1710959598 | Capital Region Medical Center | Family Medicine | 180 Northstar St, Holts Summit, MO 65043-1123 | 2006-02-06 |
| 1730151143 | Capital Region Medical Center | Family Medicine | 704 Buchanan Hwy Sw, California, MO 65018 | 2006-02-02 |
| 1285606392 | Capital Region Medical Center | Nurse Practitioner | 103 Business Hwy 54 North, Eldon, MO 65026 | 2006-02-02 |
| Street Address |
1432 SOUTHWEST BLVD |
| City | JEFFERSON CITY |
| State | MO |
| Zip Code | 65109-2444 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639166481 | Shelby D Rifkin | Internal Medicine | 1432 Southwest Blvd, Jefferson City, MO 65109-2444 | 2005-10-05 |
| 1942816897 | Ashley Nicole Bramer | Speech-Language Pathologist | 1432 Southwest Blvd, Jefferson City, MO 65109-2444 | 2020-09-16 |
| 1891319877 | Derek Scott Parker | Physical Therapist | 1432 Southwest Blvd, Jefferson City, MO 65109-2444 | 2020-06-04 |
| 1205489630 | Jamie Lynn Wilson | Social Worker | 1432 Southwest Blvd, Jefferson City, MO 65109-2444 | 2019-07-24 |
| 1902459910 | Miranda L Backes | Counselor | 1432 Southwest Blvd, Jefferson City, MO 65109-2444 | 2019-07-18 |
| 1356809297 | Stacy Lynn Stegeman | Counselor | 1432 Southwest Blvd, Jefferson City, MO 65109-2444 | 2019-03-11 |
| 1295207371 | Mary Blochberger | Specialist/Technologist | 1432 Southwest Blvd, Jefferson City, MO 65109-2444 | 2018-12-29 |
| 1053714154 | Wesley Clifford Thompson | Psychologist | 1432 Southwest Blvd, Jefferson City, MO 65109-2444 | 2014-10-02 |
| 1235473380 | Nicole Danielle Borrenpohl | Nurse Practitioner | 1432 Southwest Blvd, Jefferson City, MO 65109-2444 | 2012-11-15 |
| 1982953196 | Lynn Margaret Grant | Dietitian, Registered | 1432 Southwest Blvd, Jefferson City, MO 65109-2444 | 2012-09-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518449321 | Kara D Roderick | Physical Therapist | 1115 Fairgrounds Road, Jefferson City, MO 65109 | 2018-08-29 |
| 1851871214 | Integrative Medicine, LLC | Internal Medicine | 999 Diamond Rdg Ste 201, Jefferson City, MO 65109 | 2018-08-15 |
| 1972020394 | Rehab Care Group East, LLC | Clinic/Center | Primrose Retirement Community Jefferson City, 1214 Freedom Boulevard, Jefferson City, MO 65109 | 2017-08-25 |
| 1124558986 | Nicholas Rehagen | Specialist/Technologist | 304 Timber Creek Rd, Jefferson City, MO 65109 | 2017-06-14 |
| 1982004214 | Kara Elizabeth Wilbers | Occupational Therapist | 1105 Fairgrounds Rd, Jefferson City, MO 65109 | 2014-08-22 |
| 1942510334 | Loftin Eyecare, LLC | Optometrist | 724 West Stadium Boulevard, # 029 Walmart Vision Center, Jefferson City, MO 65109 | 2010-10-19 |
| 1306077250 | Paula Hancock Johnson | Social Worker | 1303 Edgewood Dr Ste 5, Jefferson City, MO 65109 | 2009-07-27 |
| 1679701296 | Capital Region Medical Center | Family Medicine | 3308 W Edgewood, Suite B, Jefferson City, MO 65109 | 2009-06-23 |
| 1972730141 | Nancy S Stork | Counselor | 204 Metro, Suite B, Jefferson City, MO 65109 | 2009-06-16 |
| 1356522916 | Walk Easy LLC | Durable Medical Equipment & Medical Supplies | 4810 Rainbow Dr., Jefferson City, MO 65109 | 2007-11-23 |
| Find all providers in zip 65109 | ||||
| Taxonomy Code | 2085B0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Body Imaging |
| A Radiology doctor of Osteopathy that specializes in Body Imaging. |
| Notes: Source: National Uniform Claim Committee, 2008 [7/1/2008: definiton added, source added] Additional Resources: The American Osteopathic Board of Radiology no longer offers a certificate in this specialty. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003353152 | E-cloud Radiology LLC | Radiology | 7304 Stream Valley Ct, Saint Louis, MO 63129-5291 | 2017-01-27 |
| 1184828410 | John Gerard Ryan | Radiology | Mallinckrodt Institute of Radiology - Barnesjewish Hosp, 510 South Kingshighway Blvd., Saint Louis, MO 63110 | 2007-06-12 |
| 1689742611 | Carl M Regier | Radiology | 404 Timberlane Point Rd, Branson, MO 65616-7951 | 2006-11-30 |
| 1558305052 | James Hughes Adams | Radiology | 612 Rosewood Dr, Kirksville, MO 63501-2477 | 2006-06-15 |
| 1861470734 | St Louis Pet Centers, LLC | Radiology | 12637 Olive Blvd, Creve Coeur, MO 63141-6313 | 2006-01-02 |
| 1083610539 | Gwendolyn Arnett | Radiology | 4321 Washington St, Ste 1000, Kansas City, MO 64111-5961 | 2005-06-21 |
| 1174527584 | Edward O'brien | Radiology | 9930 Watson Rd, Saint Louis, MO 63126-1827 | 2005-06-13 |
| 1982125407 | Mohamed Ahmed Ebada | Radiology | One Hospital Dr, Columbia, MO 65212-0001 | 2017-07-06 |
| 1033566740 | Ayesha Nasrullah | Radiology | One Hospital Dr, Columbia, MO 65212-0001 | 2016-05-23 |
| 1366861841 | William Cassidy Wilson Iv | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2014-04-10 |
| Find all providers with the same taxonomy | ||||
| City | JEFFERSON CITY |
| Zip Code | 65109 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.