| College Park Family Care Center Physicians Group | |
|
11755 W 112th St Suite 202 Overland Park KS 66210-2742 | |
| (913) 469-0433 | |
| Not Available |
| Full Name | College Park Family Care Center Physicians Group |
|---|---|
| Speciality | Family Medicine |
| Location | 11755 W 112th St, Overland Park, Kansas |
| Authorized Official Name and Position | Todd Carlon (VICE PRESIDENT) |
| Authorized Official Contact | 8165084090 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| College Park Family Care Center Physicians Group 11755 W 112th St Suite 202 Overland Park KS 66210-2742 Ph: (913) 469-0433 | College Park Family Care Center Physicians Group 11755 W 112th St Suite 202 Overland Park KS 66210-2742 Ph: (913) 469-0433 |
| NPI Number | 1760798540 |
|---|---|
| Provider Enumeration Date | 08/31/2010 |
| Last Update Date | 12/04/2012 |
| Medicare PECOS PAC ID | 9234318502 |
|---|---|
| Medicare Enrollment ID | O20110119001046 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760798540 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Scott Haesemeyer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326068149 PECOS PAC ID: 7618959685 Enrollment ID: I20040603000567 |
| Provider Name | Shelley L Lewis |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1265490353 PECOS PAC ID: 7113999830 Enrollment ID: I20040820000174 |
| Provider Name | Timothy Clayton Talbert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356338776 PECOS PAC ID: 4688642150 Enrollment ID: I20040922000593 |
| Provider Name | Brian C Kindred |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1366435778 PECOS PAC ID: 9537113816 Enrollment ID: I20050309000718 |
| Provider Name | Sean M Wheeler |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1376530683 PECOS PAC ID: 2062454994 Enrollment ID: I20050601000480 |
| Provider Name | Joseph Varriano |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1710954896 PECOS PAC ID: 2264324656 Enrollment ID: I20051028000459 |
| Provider Name | Dale Lee Robertson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1376512996 PECOS PAC ID: 2567440373 Enrollment ID: I20051029000122 |
| Provider Name | David Marcus |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952378069 PECOS PAC ID: 9436141579 Enrollment ID: I20051031000223 |
| Provider Name | Ellen M Yetter |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902873441 PECOS PAC ID: 9133197312 Enrollment ID: I20051031000520 |
| Provider Name | Chad Ruble |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114906245 PECOS PAC ID: 1557303831 Enrollment ID: I20051101000867 |
| Provider Name | Hilary S Nash |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619923851 PECOS PAC ID: 8426060583 Enrollment ID: I20060608000274 |
| Provider Name | Jeremy J Jagoda |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689607301 PECOS PAC ID: 5890799936 Enrollment ID: I20060905000191 |
| Provider Name | Bertrand L Gallet |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1629053152 PECOS PAC ID: 3577520295 Enrollment ID: I20060913000644 |
| Provider Name | Daniel J Gurley |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1952339749 PECOS PAC ID: 9537180088 Enrollment ID: I20061219000419 |
| Provider Name | Sarah M Baker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720073281 PECOS PAC ID: 7810981594 Enrollment ID: I20070201000177 |
| Provider Name | Trystan J Crook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437146214 PECOS PAC ID: 2264469618 Enrollment ID: I20070628000314 |
| Provider Name | Ronald R Weis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558396952 PECOS PAC ID: 9537177340 Enrollment ID: I20070827000367 |
| Provider Name | Douglas Best |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1659321438 PECOS PAC ID: 9234111675 Enrollment ID: I20070829000137 |
| Provider Name | Charles Horner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1215970736 PECOS PAC ID: 7113961632 Enrollment ID: I20070829000152 |
| Provider Name | Michilia D Harrington |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952340747 PECOS PAC ID: 4385653914 Enrollment ID: I20070918000432 |
| Provider Name | Jocelyn J Uecker |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1114949146 PECOS PAC ID: 9234026832 Enrollment ID: I20071005000339 |
| Provider Name | Melanie D Hijaz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083807853 PECOS PAC ID: 2365538485 Enrollment ID: I20071019000337 |
| Provider Name | Mitzi M Groves |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770577629 PECOS PAC ID: 8123056298 Enrollment ID: I20080428000653 |
| Provider Name | Kenton G Kaufman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588651970 PECOS PAC ID: 9537123997 Enrollment ID: I20080513000781 |
| Provider Name | Dawn Pankratz |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1043391378 PECOS PAC ID: 7113084179 Enrollment ID: I20090319000310 |
| Provider Name | Anne H Kettler |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1659368967 PECOS PAC ID: 0345399473 Enrollment ID: I20090520000637 |
| Provider Name | Wesley K Nash |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760626469 PECOS PAC ID: 3375695687 Enrollment ID: I20090717000272 |
| Provider Name | Veronika G Mcdonald |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1912096868 PECOS PAC ID: 5193879252 Enrollment ID: I20090825000096 |
| Provider Name | Paul J Peterson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1861448524 PECOS PAC ID: 8123045663 Enrollment ID: I20100125000125 |
| Provider Name | Calvin E Beck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710974100 PECOS PAC ID: 8820179096 Enrollment ID: I20100324000687 |
| Provider Name | David E Dobratz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245226166 PECOS PAC ID: 3274668660 Enrollment ID: I20100324000746 |
| Provider Name | John S Goza |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1760481105 PECOS PAC ID: 1759295322 Enrollment ID: I20100503000093 |
| Provider Name | Gregory E Chambon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861489205 PECOS PAC ID: 6507994498 Enrollment ID: I20100513000871 |
| Provider Name | James A Rahto |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902892862 PECOS PAC ID: 3476634643 Enrollment ID: I20100513000923 |
| Provider Name | Michael John Ferguson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700873932 PECOS PAC ID: 3274502265 Enrollment ID: I20100513000986 |
| Provider Name | Charles M Sullivan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144217530 PECOS PAC ID: 0840328746 Enrollment ID: I20100513001021 |
| Provider Name | Jeffrey M Kaplan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1730176041 PECOS PAC ID: 1951397371 Enrollment ID: I20100518000103 |
| Provider Name | Tom E Kettler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285621615 PECOS PAC ID: 4587690110 Enrollment ID: I20100518000748 |
| Provider Name | Robert L Schuchardt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346237773 PECOS PAC ID: 9830270008 Enrollment ID: I20100524000585 |
| Provider Name | Holly A Kaufman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851388243 PECOS PAC ID: 4183753502 Enrollment ID: I20100524000624 |
| Provider Name | Suzanne H Shaffer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528056157 PECOS PAC ID: 9335278779 Enrollment ID: I20100524000783 |
| Provider Name | Mark L Gillett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497742886 PECOS PAC ID: 5092896266 Enrollment ID: I20100604000346 |
| Provider Name | Khaled R Girgis |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1104813419 PECOS PAC ID: 2365572161 Enrollment ID: I20100604000381 |
| Provider Name | Gregory L Curry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750377719 PECOS PAC ID: 0648300277 Enrollment ID: I20100609000055 |
| Provider Name | Frederick A Church |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215924600 PECOS PAC ID: 8729118351 Enrollment ID: I20100609000065 |
| Provider Name | Young J Cho |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154359891 PECOS PAC ID: 6406910124 Enrollment ID: I20100611000831 |
| Provider Name | Staci M Jordan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831185750 PECOS PAC ID: 2062543853 Enrollment ID: I20100622000829 |
| Provider Name | Christopher D Wright |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043207426 PECOS PAC ID: 1254462518 Enrollment ID: I20100630000319 |
| Provider Name | Mark R Kahler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518953561 PECOS PAC ID: 9931280104 Enrollment ID: I20100630000350 |
| Provider Name | Bruce W Young |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487641866 PECOS PAC ID: 1850422114 Enrollment ID: I20100630000371 |
| Provider Name | Jeffrey A Hicklin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083729222 PECOS PAC ID: 3173606332 Enrollment ID: I20100707000117 |
| Provider Name | Michael Dennis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1184644288 PECOS PAC ID: 1456434612 Enrollment ID: I20100713000147 |
| Provider Name | Theodore W Pope |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1184647935 PECOS PAC ID: 8820177835 Enrollment ID: I20100813001068 |
| Provider Name | Scott Culbertson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1629276555 PECOS PAC ID: 7810180098 Enrollment ID: I20101020000538 |
| Provider Name | Amy J Kapple |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1437399342 PECOS PAC ID: 9830384585 Enrollment ID: I20101108001410 |
| Provider Name | Mary E Willis |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1710127626 PECOS PAC ID: 3375738024 Enrollment ID: I20101108001433 |
| Provider Name | Diadra L Harnden |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1629282918 PECOS PAC ID: 3274728928 Enrollment ID: I20101108001445 |
| Provider Name | Kristen C Ferrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336443274 PECOS PAC ID: 5294912846 Enrollment ID: I20110607000718 |
| Provider Name | Ngoc-lan Thi Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033157086 PECOS PAC ID: 0345285979 Enrollment ID: I20110726000798 |
| Provider Name | Diane D Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942498787 PECOS PAC ID: 2466510243 Enrollment ID: I20110825000617 |
| Provider Name | Suzan M Lewis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811045156 PECOS PAC ID: 5193980084 Enrollment ID: I20120627000039 |
| Provider Name | Brooke Mcguire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780952127 PECOS PAC ID: 4789838459 Enrollment ID: I20130205000077 |
| Provider Name | Wyatt Hadley |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1942454897 PECOS PAC ID: 1153455829 Enrollment ID: I20130423000064 |
| Provider Name | Sharon R Milberger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508133349 PECOS PAC ID: 2567620446 Enrollment ID: I20130627000126 |
| Provider Name | Nebiyu M Beteselassie |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1982822847 PECOS PAC ID: 2466621297 Enrollment ID: I20130722000124 |
| Provider Name | Lisa M Sinkler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578987210 PECOS PAC ID: 3375776180 Enrollment ID: I20140501001715 |
| Provider Name | Paul J Gass |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1235241647 PECOS PAC ID: 4981702669 Enrollment ID: I20140821001387 |
| Provider Name | Hannah L Jenkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760888671 PECOS PAC ID: 2567786965 Enrollment ID: I20150113000632 |
| Provider Name | Erin U Feitz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801078308 PECOS PAC ID: 0648347716 Enrollment ID: I20150617002712 |
| Provider Name | Jennifer A Chester |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447582721 PECOS PAC ID: 1052571379 Enrollment ID: I20150708002278 |
| Provider Name | Cristina L Jacobs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548646946 PECOS PAC ID: 5698081727 Enrollment ID: I20150903000812 |
| Provider Name | Amanda Morris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548622590 PECOS PAC ID: 2961793583 Enrollment ID: I20160628002852 |
| Provider Name | Matthew Towsley |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1396061966 PECOS PAC ID: 3971815143 Enrollment ID: I20160713002564 |
| Provider Name | Bradley Craemer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134500846 PECOS PAC ID: 1951615038 Enrollment ID: I20160920001225 |
| Provider Name | Susan Gutschow |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841516226 PECOS PAC ID: 2062729114 Enrollment ID: I20160923001673 |
| Provider Name | Marisa D Argubright |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245679760 PECOS PAC ID: 9739486754 Enrollment ID: I20161006000486 |
| Provider Name | John W Grisham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972983849 PECOS PAC ID: 2769796887 Enrollment ID: I20161228001784 |
| Provider Name | Heather A Grisham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174938179 PECOS PAC ID: 3476779125 Enrollment ID: I20170111001975 |
| Provider Name | Jeremy B Kirchoff |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033352737 PECOS PAC ID: 1557554565 Enrollment ID: I20170719001617 |
| Provider Name | Brooke L Dougan |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1881129112 PECOS PAC ID: 0547530693 Enrollment ID: I20170721001246 |
| Provider Name | Logan G Smith |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1467975441 PECOS PAC ID: 9830461482 Enrollment ID: I20170817000880 |
| Provider Name | Lisa H Hutchison |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396793923 PECOS PAC ID: 3173560760 Enrollment ID: I20170830003438 |
| Provider Name | Julie R Mclean |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1649510835 PECOS PAC ID: 4486912466 Enrollment ID: I20171220002575 |
| Provider Name | Nida Gursel Dillon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003222563 PECOS PAC ID: 2062639461 Enrollment ID: I20180301000610 |
| Provider Name | Randolph Augustus Malone |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1497726814 PECOS PAC ID: 2567597438 Enrollment ID: I20180525000883 |
| Provider Name | Christopher Thomas Cummings |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1033473889 PECOS PAC ID: 4284955733 Enrollment ID: I20180806000767 |
| Provider Name | Jenna Beth Kawase Eshcol |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891175527 PECOS PAC ID: 0547575821 Enrollment ID: I20181005000798 |
| Provider Name | Valery C Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871529065 PECOS PAC ID: 1153350616 Enrollment ID: I20191023001716 |
| Provider Name | Sarah Kurian |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548688567 PECOS PAC ID: 3274756622 Enrollment ID: I20200803001416 |
| Provider Name | Robert J Klug |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225523699 PECOS PAC ID: 7618226325 Enrollment ID: I20210302003146 |
| Provider Name | Lara S Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730573122 PECOS PAC ID: 4587975354 Enrollment ID: I20210331002450 |
| Provider Name | Daniel Childers |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1386039337 PECOS PAC ID: 1951698851 Enrollment ID: I20210409000566 |
| Provider Name | Lindsay Marie Lehechka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942833256 PECOS PAC ID: 4385073618 Enrollment ID: I20210510000162 |
| Provider Name | Joel Schmidt |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1750765558 PECOS PAC ID: 9032511811 Enrollment ID: I20210715003919 |
| Provider Name | Caleb Tague |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740774447 PECOS PAC ID: 0446654016 Enrollment ID: I20210803003766 |
| Provider Name | Zachary Hill |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1205299849 PECOS PAC ID: 1850683376 Enrollment ID: I20210804001560 |
| Provider Name | Chelsea N Fair |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003348095 PECOS PAC ID: 7214209873 Enrollment ID: I20210804002644 |
| Provider Name | Brittany N Lambert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417448424 PECOS PAC ID: 0547518631 Enrollment ID: I20210816000140 |
| Provider Name | Tyler Downs |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1750991238 PECOS PAC ID: 4880082098 Enrollment ID: I20211020002296 |
| Provider Name | Erin E Shumate |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1508144718 PECOS PAC ID: 7618148040 Enrollment ID: I20220314000723 |
| Provider Name | John Burns |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1255780029 PECOS PAC ID: 2961798897 Enrollment ID: I20220516000471 |
| Provider Name | Peter Winningham |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1811239296 PECOS PAC ID: 5395046189 Enrollment ID: I20220517000297 |
| Provider Name | Mollyanne Elizabeth Gibson Brunkow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487114971 PECOS PAC ID: 9931584158 Enrollment ID: I20220923000921 |
| Provider Name | Jared Lee Hodgson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1932595626 PECOS PAC ID: 1456653450 Enrollment ID: I20221205001566 |
| Provider Name | Sandeep Reddy |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1437513322 PECOS PAC ID: 0648563965 Enrollment ID: I20221216000279 |
| Provider Name | Brian Kim |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1558899716 PECOS PAC ID: 2466724026 Enrollment ID: I20221220000509 |
| Provider Name | Scott A Drummond |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1962552604 PECOS PAC ID: 2163783531 Enrollment ID: I20230323002341 |
| Provider Name | Kari Lynne Burns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871294868 PECOS PAC ID: 0244697597 Enrollment ID: I20230601001792 |
| Provider Name | Matthew Mader |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578096566 PECOS PAC ID: 3971861725 Enrollment ID: I20230711004156 |
| Provider Name | Nicole Marie Wampler |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1689366650 PECOS PAC ID: 3779946611 Enrollment ID: I20230825000764 |
| Provider Name | Madeline Marie Howell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659065373 PECOS PAC ID: 3577927417 Enrollment ID: I20230912001126 |
| Provider Name | Johanna Dobard |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1184153769 PECOS PAC ID: 7315325065 Enrollment ID: I20230921001503 |
| Provider Name | Karina Burton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629708854 PECOS PAC ID: 7618321662 Enrollment ID: I20230926001276 |
| Provider Name | David Victor Smullen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1912969510 PECOS PAC ID: 7315945839 Enrollment ID: I20231116002858 |
| Provider Name | Michael Applebaum |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1760825814 PECOS PAC ID: 2264782804 Enrollment ID: I20231118000449 |
| Provider Name | Vladimir Ivanovic |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578542767 PECOS PAC ID: 9830102276 Enrollment ID: I20240105002567 |
| Provider Name | Douglas Wesley White |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1538140322 PECOS PAC ID: 7012055973 Enrollment ID: I20240122001587 |
| Provider Name | David Thomas Rockwell |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326067117 PECOS PAC ID: 9638167398 Enrollment ID: I20240207002045 |
Midwest Hospital Specialists, P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 10901 Granada Ln, Ste. 200, Overland Park, KS 66211 Phone: 913-660-1616 Fax: 913-660-1664 | |
Francisco M. Garcia, M D Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 10640 W 87th St, Overland Park, KS 66214 Phone: 913-888-0780 Fax: 913-888-3402 | |
Millie Medical Of Kansas, P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 12022 Blue Valley Pkwy Ste 523, Overland Park, KS 66213 Phone: 561-476-0060 | |
Saint Lukes Physician Group Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8501 W 95th St, Overland Park, KS 66212 Phone: 913-323-8880 | |
Optum Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6860 W 115th St, Overland Park International Trade, Overland Park, KS 66211 Phone: 800-645-9656 | |
Optum Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6860 W 115th St, Overland Park, KS 66211 Phone: 913-253-0601 | |
Spira Innovations, Llc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: Spira Care Overland Park 7341 W. 133rd St, Overland Park, KS 66213 Phone: 191-329-7747 |