CMS-1500 Box 24J / 33a • NPI
1043817323
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
363LF0000X (CMS 50)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family
Box 32 Service Location & ZIP+4
2215 BROADWAY ST, CAPE GIRARDEAU, MO, 63701-4403
✓ 9-Digit EDI 837 ZIP+4 (63701-4403)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1043817323 (MISSOURI MEDICAL PROVIDERS LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1043817323 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | MISSOURI MEDICAL PROVIDERS LLC |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family NUCC Code: 363LF0000X (Nurse Practitioner, Family) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 2215 BROADWAY ST, CAPE GIRARDEAU, MO, 63701-4403 |
| Practice Telephone / Fax | Tel: (636) 725-1255 | Fax: (573) 534-3131 |
| Administrative Mailing Address | 2215 BROADWAY ST, CAPE GIRARDEAU, MO, 63701-4403 |
| Enumeration & Last Sync | Enumerated: 2020-10-08 | CMS Record Updated: 2026-04-13 |
| Authorized Official | OMER MALIK (Owner) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (363LF0000X)
What Does Taxonomy Code 363LF0000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LF0000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (MISSOURI MEDICAL PROVIDERS LLC)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
363L00000X — Nurse PractitionerPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner | State: N/A | License: Verified | Primary: Secondary |
363LP0808X — Nurse Practitioner, Psych/Mental HealthPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health | State: N/A | License: Verified | Primary: Secondary |
163WW0000X — Registered Nurse, Wound CarePlain English: Licensed & Credentialed Registered Nurse, Wound Care | State: N/A | License: Verified | Primary: Secondary |
363LF0000X — Nurse Practitioner, FamilyPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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