BLACK RIVER MEDICAL GROUP, LLC (NPI# 1386998318) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386998318 |
| Entity Type | Organization |
| Organization Name | BLACK RIVER MEDICAL GROUP, LLC |
| Other Organization Name | BLACK RIVER MEDICAL PARTNERS |
| Practice Address |
225 Physicians Park Suite 204 Poplar Bluff MO 63901-3956 |
| Mailing Address |
217 Physicians Park Drive Poplar Bluff MO 63901-3956 |
| Practice Telephone | 5737854601 |
| Mailing Telephone | 5737279125 |
| Mailing Fax Number | 5736861245 |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2012-11-26 |
| Authorized Official Name | MR. MICHAEL G BURCHAM SR. (PRESIDENT & CEO) |
| Authorized Official Telephone | 5737279125 |
| Authorized Official Credential | MBA, RRT |
| Is Organization Subpart | Y |
| Parent Organization Name | BLACK RIVER COMMUNITY MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Black River Medical Partners | Doing Business As Name - Organization |
| Street Address |
225 PHYSICIANS PARK SUITE 204 |
| City | POPLAR BLUFF |
| State | MO |
| Zip Code | 63901-3956 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710965371 | Gilbert D Smith | Family Medicine | 225 Physicians Park, Suite 400, Poplar Bluff, MO 63901-3956 | 2006-01-04 |
| 1376008334 | Zachary L Ferguson | Physician Assistant | 225 Physicians Park, Poplar Bluff, MO 63901-3935 | 2019-02-04 |
| 1316486202 | Vanessa Adams | Nurse Practitioner | 225 Physicians Park, Ste 203, Poplar Bluff, MO 63901-3935 | 2017-02-13 |
| 1134589625 | Ssm Neurosciences, Inc. | Neurological Surgery | 225 Physicians Park, Suite 102, Poplar Bluff, MO 63901-3935 | 2016-02-26 |
| 1275991861 | Southern Care and Comfort In Home Agency, LLC | In Home Supportive Care | 225 Physicians Park, Suite 301, Poplar Bluff, MO 63901-3935 | 2016-02-10 |
| 1215305941 | Christian Bowers | Nurse Practitioner | 225 Physicians Park, Suites 400 & 104, Poplar Bluff, MO 63901-3935 | 2015-09-11 |
| 1730586777 | Mark Gerard Smith | Physical Therapist | 225 Physicians Park, Suite 101, Poplar Bluff, MO 63901-3956 | 2014-11-19 |
| 1689096919 | Saint Francis Medical Center | Internal Medicine | 225 Physicians Park, Ste 400, Poplar Bluff, MO 63901-3956 | 2014-01-06 |
| 1609157403 | Joyce A Barklow | Nurse Practitioner | 225 Physicians Park, Suite 203, Poplar Bluff, MO 63901-3956 | 2011-09-07 |
| 1265712780 | Amber Wheeler Richardson | Psychologist | 225 Physicians Park, Ste 300, Poplar Bluff, MO 63901-3930 | 2011-08-29 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568076701 | Alternative Sleep Solution | Dentist | 2700 Kanell Blvd., Poplar Bluff, MO 63901 | 2020-09-04 |
| 1285271239 | Front Door Wellness LLC | Physical Therapist | Front Door Wellness LLC, 5835 Quail Meadows Drive, Poplar Bluff, MO 63901 | 2019-12-09 |
| 1104470368 | Andrew Akindutire | Dentist | 3101 Oak Groove Rd., Suite 6, Poplar Bluff, MO 63901 | 2019-07-26 |
| 1780195966 | Midwest Equipment Srv Systems LLC | Technician, Pathology | 2400 Lucy Lee Parkway, Suite C, Poplar Bluff, MO 63901 | 2017-10-16 |
| 1801259387 | Richard Justin Huber | Technician, Other | 3005 Warrior Ln, Poplar Bluff, MO 63901 | 2016-04-01 |
| 1699136275 | Donja Kirkland | Recreation Therapist | 1910a Greenwood Dr., Suite D, Poplar Bluff, MO 63901 | 2016-03-10 |
| 1760866867 | Bio-medical Applications of Missouri, Inc. | Clinic/Center | 3050 Tucker Road, Poplar Bluff, MO 63901 | 2015-07-17 |
| 1407246390 | Lisa Marie Payne | Physical Therapist | 4358c Highway Pp, Poplar Bluff, MO 63901 | 2015-01-29 |
| 1700202488 | Missouri Dental Professionals, Richard Straus, Dmd, PC | Dentist | 1602 W. Harper Street, Poplar Bluff, MO 63901 | 2014-03-05 |
| 1932521648 | Essential Family Healthcare, LLC | Clinic/Center | 1369 North Westwood Blvd., Poplar Bluff, MO 63901 | 2014-01-15 |
| Find all providers in zip 63901 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| 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 Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922375492 | John Paul Christy | Surgery | 2423 County Road 459, Poplar Bluff, MO 63901-7664 | 2011-11-28 |
| 1821077660 | Kean D Griffith | Surgery | 3098 Oak Grove Rd, Poplar Bluff, MO 63901-8938 | 2006-01-11 |
| 1750370748 | James William Gieselmann | Surgery | 2210 Barron Rd, Suite 122, Poplar Bluff, MO 63901-1908 | 2005-10-21 |
| 1386118917 | Saint Francis Medical Center | Surgery | 225 Physicians Park Ste 301, Poplar Bluff, MO 63901-3930 | 2019-01-16 |
| 1487859609 | Stanley Preston Jones | Surgery | 3100 Oak Grove Rd, Poplar Bluff, MO 63901-1573 | 2007-06-18 |
| 1740245737 | David M Mcfadden | Surgery | 621 W Pine St, Poplar Bluff, MO 63901-5042 | 2006-04-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134623317 | Kuirong Jiang | Surgery | 1 Hospital Dr Rm Mc520, Columbia, MO 65212-1000 | 2018-03-21 |
| 1962926311 | Blaire Lori Anderson | Surgery | 4921 Parkview Place Ste 8c, St Louis, MO 63110 | 2017-07-27 |
| 1578084349 | Shoaib Safiullah | Surgery | 1 Hospital Dr # Dc075.00, Columbia, MO 65212-1000 | 2017-07-03 |
| 1003336934 | Bradley Kushner | Surgery | 660 S Euclid Ave Fl 9, Saint Louis, MO 63110-1010 | 2017-06-21 |
| 1982088571 | Maxwell Tanyi Fohtung | Surgery | 4949 W Pine Blvd, Saint Louis, MO 63108 | 2015-07-14 |
| 1376920538 | Jordan M Kirsch | Surgery | 660 S. Euclid Ave, Cb 8109, Saint Louis, MO 63110-1020 | 2015-04-27 |
| 1194117861 | Kaitlyn Marie Rountree | Surgery | 1 Hospital Dr # Mc404, Columbia, MO 65212-1000 | 2015-03-04 |
| 1003231002 | Mysorekar Surgical | Surgery | 8342 Delcrest Dr, Apt 303, Saint Louis, MO 63124-2100 | 2014-02-27 |
| 1588099725 | Francis Milton Corry | Surgery | 2859 E. Utica, Springfield, MO 65804 | 2013-09-06 |
| 1710327879 | Jason Matthew Loden | Surgery | 1333 S Sam Houston Blvd Ste C, Houston, MO 65483-2046 | 2013-07-03 |
| Find all providers with the same taxonomy | ||||
| City | POPLAR BLUFF |
| Zip Code | 63901 |
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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.