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Carissa Michelle White

Radiology

Allopathic & Osteopathic Physicians

One Hospital Dr, Columbia, MO 65212-0001

PECOS Enrollment

This provider is enrolled in PECOS as CARISSA WHITE.

Based on the most recent information from CMS, provider Carissa Michelle White is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1982959342
Provider Type
Individual
Full Name
White, Carissa Michelle
Title
Dr.
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
7/20/2012
Last Updated
9/19/2023

Contact Information

Practice Location

One Hospital Dr, Columbia, MO 65212-0001

(573) 884-7770

(573) 882-9876

Mailing Location

PO Box 843966, Kansas City, MO 64184-3966

(573) 884-3300

(573) 884-0943

Provider Taxonomies

Code	Description	License
Code 2085R0202X Primary	Description Radiology Allopathic & Osteopathic Physicians	License 2023033640 Missouri
Code 2085R0202X	Description Radiology Allopathic & Osteopathic Physicians	License MD466353 Pennsylvania

Provider Identifiers

ID	Description	Issuer
ID 103599188	Description Medicaid	Issuer Unlisted Pennsylvania
ID 2103309	Description Medicaid	Issuer Unlisted Washington

Carissa Michelle White

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Aro, Michael Rantiolu

Baqar, Mohammad

Al-Sabbagh, Mustafa

Garg, Megha

Altes, Talissa Ann

Abdelaziz, Amr Samy Mohamed

Wissman, Robert David

Schmidt, Joel

Kumar, Pragati

Vega, Benjamin Sherwood