CAPITAL REGION MEDICAL CENTER (NPI# 1700043791) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700043791 |
| Entity Type | Organization |
| Organization Name | CAPITAL REGION MEDICAL CENTER |
| Other Organization Name | CAPITAL REGION PHYSICIANS - RADIOLOGY |
| Practice Address |
1125 Madison St Jefferson City MO 65102-5227 |
| Mailing Address |
Po Box 1128 Jefferson City MO 65102-1128 |
| Practice Telephone | 5736325000 |
| Practice Fax Number | 5736325876 |
| Mailing Telephone | 5736325000 |
| Mailing Fax Number | 5736325876 |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2013-08-23 |
| Authorized Official Name | TOM LUEBBERING (VP OF FINANCE) |
| Authorized Official Telephone | 5736325100 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 507398006 | 05 |
| Other Name | Type Code |
|---|---|
| Capital Region Physicians - Radiology | 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 |
1125 MADISON ST |
| City | JEFFERSON CITY |
| State | MO |
| Zip Code | 65102-5227 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912900085 | Elizabeth A Blanchard | Obstetrics & Gynecology | 1125 Madison St, Jefferson City, MO 65101-5227 | 2005-05-23 |
| 1740807031 | Courtney R Kunze | Nurse Practitioner | 1125 Madison St, Jefferson City, MO 65101-5200 | 2020-07-02 |
| 1528685906 | Garrett Hull | Family Medicine | 1125 Madison St, Jefferson City, MO 65101-5227 | 2020-07-01 |
| 1508499278 | Amy L Wyatt | Nurse Practitioner | 1125 Madison St, Jefferson City, MO 65101-5227 | 2020-02-20 |
| 1982257960 | Kahlil A Gaiters | Student in an Organized Health Care Education/Training Program | 1125 Madison St, Jefferson City, MO 65101-5200 | 2019-07-19 |
| 1710548821 | Erin Nicole Smallmon | Family Medicine | 1125 Madison St, Jefferson City, MO 65101-5200 | 2019-06-28 |
| 1215598602 | Brian Vause | Family Medicine | 1125 Madison St, Jefferson City, MO 65101-5227 | 2019-06-26 |
| 1770147266 | Heghineh Galstian | Family Medicine | 1125 Madison St, Jefferson City, MO 65101-5227 | 2019-04-30 |
| 1659935005 | Anna Marie Milner | Registered Nurse | 1125 Madison St, Jefferson City, MO 65101-5227 | 2019-04-30 |
| 1972076750 | Jennifer Esther Wekenborg | Physician Assistant | 1125 Madison St, Jefferson City, MO 65101-5200 | 2019-01-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649514050 | Capital Region Resident Clinic | General Practice | 220 Madison St., Jefferson City, MO 65102 | 2012-11-26 |
| 1659534386 | Cynthia L Hackathorn | Counselor | 1706 E Elm St, Jefferson City, MO 65102 | 2008-07-02 |
| 1821097783 | Scott Marrs | Family Medicine | 2511 W Edgewood, Ste D, Jefferson City, MO 65102 | 2005-07-21 |
| 1255487948 | Lynne Anne White | Occupational Therapist | 1125 Madison, Jefferson, MO 65102-1128 | 2007-01-26 |
| 1003872714 | Elbert Stinson Tillerson | Psychiatry & Neurology | 1125 Madison St., Jefferson City, MO 65102-1128 | 2006-04-21 |
| 1932429727 | Jonathan Andrew Heisinger | Health Educator | 1505 Southwest Blvd, Jefferson City, MO 65102-1128 | 2010-06-03 |
| 1164665766 | Colin Duggan | Psychologist | 1432 Southwest Blvd, Jefferson City, MO 65102-1128 | 2009-04-13 |
| 1013120583 | Christie L Stockton | Physical Therapist | 1125 Madison, Jefferson City, MO 65102-1128 | 2007-05-08 |
| 1265577852 | Bethany Naughton | Occupational Therapist | 1432 Southwest Blvd, Captial Region Home Health, Jefferson City, MO 65102-1128 | 2007-02-21 |
| 1639287915 | Heather Mcbee Johns | Social Worker | 1432 Southwest Blvd, Jefferson City, MO 65102-1128 | 2006-08-28 |
| Find all providers in zip 65102 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487012142 | Correctional Medical Imaging, Inc. | Radiology | 1001 Southwest Blvd Ste C, Jefferson City, MO 65109-2501 | 2016-02-09 |
| 1477818698 | Correctional Medical Imaging, Inc. | Radiology | 2713 Industrial Dr Ste C, Jefferson City, MO 65109-6705 | 2012-07-13 |
| 1568621175 | Advanced Radiology of Jefferson City, LLC | Radiology | 3218 W Edgewood Dr Ste 200, Jefferson City, MO 65109-6951 | 2008-06-09 |
| 1114025079 | Donald K Mcnutt | Radiology | 2713 Industrial Dr, Suite C, Jefferson City, MO 65109-6705 | 2006-09-21 |
| 1366508327 | Jefferson City Medical Group, P.C. | Radiology | 1241 W Stadium Blvd, Lower Level, Jefferson City, MO 65109-6023 | 2006-12-27 |
| 1558455196 | Mitchell Teruichi Godbee | Radiology | 1125 Madison St, Jefferson City, MO 65101-5227 | 2006-10-03 |
| 1861583544 | Marcus Jerome Wade | Radiology | 1241 W Stadium Blvd, Jefferson City, MO 65109-6023 | 2006-09-27 |
| 1508964479 | Denzil J. Hawes-davis | Radiology | 1125 Madison St, Jefferson City, MO 65101-5227 | 2006-09-21 |
| 1235238056 | Missouri Medical Imaging, Inc. | Radiology | 1125 Madison St, Jefferson City, MO 65101-5227 | 2006-09-21 |
| 1649378597 | Dennis C Luetkemeyer | Radiology | 1705 Christy Dr, Suite #104, Jefferson City, MO 65101-5195 | 2006-09-21 |
| Find all providers in JEFFERSON CITY | ||||
| City | JEFFERSON CITY |
| Zip Code | 65102 |
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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.