CMS-1500 Box 24J / 33a • NPI
1366752768
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
207Q00000X (CMS 08)
Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor)
Box 32 Service Location & ZIP+4
1502 N JEFFERSON ST, ST SUITE A B, CARROLLTON, MO, 64633-1948
✓ 9-Digit EDI 837 ZIP+4 (64633-1948)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1366752768 (CARROLL COUNTY MEDICAL CLINIC) 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 | 1366752768 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | CARROLL COUNTY MEDICAL CLINIC |
| Plain-English Specialty | Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor) NUCC Code: 207Q00000X (Family Medicine) |
| Certifying / Licensing Body | American Board of Family Medicine (ABFM) |
| Practice Location Address | 1502 N JEFFERSON ST, ST SUITE A B, CARROLLTON, MO, 64633-1948 |
| Practice Telephone / Fax | Tel: (660) 542-3865 | Fax: (660) 542-0336 |
| Administrative Mailing Address | 1502 N JEFFERSON ST, CARROLLTON, MO, 64633-1948 |
| Enumeration & Last Sync | Enumerated: 2010-10-19 | CMS Record Updated: 2010-10-19 |
| Authorized Official | JERRY DOVER (CEO) |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (207Q00000X)
What Does Taxonomy Code 207Q00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207Q00000X translates to:
"Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor)"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (CARROLL COUNTY MEDICAL CLINIC)
Typical CPT / Diagnostic Procedures:- Comprehensive Annual Preventive Physical Examination & Cardiometabolic Screening
- Outpatient ECG / EKG Interpretation (CPT 93000) & Ambulatory BP Monitoring
- Point-of-Care HbA1c, Lipid Panel, Urinalysis & BMI Risk Stratification
- Minor Office Procedures: Wound Suturing, Abscess Drainage & Joint Injections
- Adult & Pediatric Immunization Administration (Tetanus/Tdap, Influenza, HPV)
- Metformin, SGLT2 Inhibitors & GLP-1 Receptor Agonists (Type 2 Diabetes)
- Lisinopril, Losartan & Amlodipine (First-Line Hypertension Management)
- Atorvastatin & Rosuvastatin (Cardiovascular Lipid Optimization)
- Nitrofurantoin, Trimethoprim-Sulfamethoxazole & Ciprofloxacin (Outpatient UTIs)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
207Q00000X — Family MedicinePlain English: Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor) | State: MO | License: MD109202 | Primary: Secondary |
207R00000X — Internal MedicinePlain English: Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician) | State: MO | License: MD106594 | Primary: Secondary |
2080A0000X — Pediatrics, Adolescent MedicinePlain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) | State: MO | License: MD109202 | Primary: Secondary |
207Q00000X — Family MedicinePlain English: Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor) | State: MO | License: MD106594 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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