| Liveactive Primary Care, LLC | |
|
6650 W 110th St Ste 220 Overland Park KS 66211-1501 | |
| (913) 549-3884 | |
| Not Available |
| Full Name | Liveactive Primary Care, LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 6650 W 110th St Ste 220, Overland Park, Kansas |
| Authorized Official Name and Position | Haseeb a Ahmed (SOLE OWNER) |
| Authorized Official Contact | 9135493884 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Liveactive Primary Care, LLC 7111 W 151st St Ste 303 Overland Park KS 66223-2231 Ph: (913) 549-3884 | Liveactive Primary Care, LLC 6650 W 110th St Ste 220 Overland Park KS 66211-1501 Ph: (913) 549-3884 |
| NPI Number | 1245686625 |
|---|---|
| Provider Enumeration Date | 05/04/2016 |
| Last Update Date | 11/17/2021 |
| Certification Date | 11/17/2021 |
| Medicare PECOS PAC ID | 9537414321 |
|---|---|
| Medicare Enrollment ID | O20190403000721 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245686625 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| 207RC0000X | Internal Medicine - Cardiovascular Disease | () | Secondary |
| 208M00000X | Hospitalist | () | Secondary |
| Provider Name | Haseeb Ahmed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972701571 PECOS PAC ID: 4587788013 Enrollment ID: I20100916000966 |
| Provider Name | Ramiro Montemayor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467001982 PECOS PAC ID: 4587078407 Enrollment ID: I20210210000276 |
| Provider Name | Madeleine J Dusselier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689338980 PECOS PAC ID: 7618361122 Enrollment ID: I20220228000601 |
| Provider Name | Marian L Phelps |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114684313 PECOS PAC ID: 2668867078 Enrollment ID: I20220322002312 |
| Provider Name | Junaid Ahmed |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1376830109 PECOS PAC ID: 1759530934 Enrollment ID: I20231115003324 |
| Provider Name | Madeline Moding Bartsch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265260665 PECOS PAC ID: 1456882208 Enrollment ID: I20241003001314 |
| Provider Name | Sheza Faruqi |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1013725803 PECOS PAC ID: 8820599509 Enrollment ID: I20260219002745 |
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