OrganizationActive
Primary Care of Bonne Terre LLC
NPI 1962883751 · General Practice Physician · Bonne Terre, MO
Provider details
- NPI number
- 1962883751
- Entity type
- Organization
- Primary specialty
- General Practice PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Andrew Ninichuck, Owner(573) 358-9119
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Primary Care Clinic/Center261QP2300X
Ambulatory Health Care Facilities
Profile Score
Established profile(73/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
527 Benham St
Bonne Terre, MO 63628-1205
Phone: (573) 358-9119
Fax: (573) 358-9489
Street-level locationGet directions
Mailing address
527 Benham St
Bonne Terre, MO 63628-1205
Other names (DBA / former)
- Doing business as
- Primary Care of Bonne Terre
Registry dates
- Enumerated
- 2015-06-17
- Last updated
- 2015-11-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.