| Brad A Mouse, DO | |
|
1101 Nw Pamela Blvd, Suite A, Grain Valley, MO 64029-7841 | |
| (816) 295-1606 | |
| (816) 295-1606 |
| Full Name | Brad A Mouse |
|---|---|
| Gender | Male |
| Speciality | Family Practice |
| Experience | 40 Years |
| Location | 1101 Nw Pamela Blvd, Grain Valley, Missouri |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588604979 | NPI | - | NPPES |
| 18960020 | Other | CFU BCBS | |
| 13384041 | Other | BCBS PROVIDER NUMBER | |
| 080148316 | Other | MO | RR MEDICARE |
| 481159444 | Other | TAX ID | |
| 2057742 | Other | AETNA | |
| 1588604979 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | R9G82 (Missouri) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| St Lukes Hospital Of Kansas City | Kansas city, MO | Hospital |
| Centerpoint Medical Center | Independence, MO | Hospital |
| Entity Name | Diamond Medical Care, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1770978413 PECOS PAC ID: 9739493081 Enrollment ID: O20150731014643 |
| Mailing Address | Practice Location Address |
|---|---|
| Brad A Mouse, DO 1101 Nw Pamela Blvd, Suite A, Grain Valley, MO 64029-7841 Ph: (816) 295-1606 | Brad A Mouse, DO 1101 Nw Pamela Blvd, Suite A, Grain Valley, MO 64029-7841 Ph: (816) 295-1606 |
Randall Lee Culbertson, DO Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 29508 E Pink Hill Rd, Grain Valley, MO 64029 Phone: 816-251-4724 Fax: 816-246-4850 | |
Jennifer Lynn Kaberline, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1439 S Minter Way, Grain Valley, MO 64029 Phone: 816-404-6785 Fax: 816-404-6724 | |
Rachel E Gordon, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1439 S Minter Way, Grain Valley, MO 64029 Phone: 816-404-6797 |