Unknown Individual – Family Nurse Practitioner, NPI 1043515034
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
7,017 NURSE PRACTITIONER in MO
Provider Addresses for Unknown Individual
2829 S. JACKSON AVENUE
JOPLIN, MO 64804
Phone: (417) 624-0440
Fax: (417) 624-9652
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 166 Open Payments records for all available years, with a total value of $3,315.
Total Amount is formed as General ($3,315) + Research ($0) + Ownership ($0) = $3,315.
Last reported payment date: 2024-12-20 • Largest payer in this snapshot: ABBVIE INC. ($613).
Total Amount
$3,315
General + Research + Ownership
Payments
166
Total payment records
General Amount
$3,315
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-20
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $613 |
| Janssen Biotech, Inc. | $606 |
| E.R. Squibb & Sons, L.L.C. | $528 |
| GENZYME CORPORATION | $280 |
| Dermavant Sciences, Inc. | $100 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20210222000436 | I | Nurse Practitioner | OK | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 3,587 | 598 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 1,580 | 1,098 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 1,009 | 761 | $0 |
| 17110 | Destruction of skin growth, 1-14 growths | 613 | 534 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 259 | 259 | $0 |
Insurance plans in this area (ZIP 64804)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| NURSE PRACTITIONER | MO | 17003 | Destruction of 2-14 skin growths | 4959 | 765 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Dermatology, Micrographic Dermatologic Surgery (Mds) | MO | |
| D E R M A T O L O G Y | MO | |
| Plastic And Reconstructive Surgery | KS | |
| D E R M A T O L O G Y | KS | |
| D E R M A T O L O G Y | KS | |
| D E R M A T O L O G Y | KS | |
| D E R M A T O L O G Y | KS | |
| Physician Assistant | KS | |
| Nurse Practitioner | WI | |
| Physician Assistant | TX |
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