NPIMap

Organization Active NPI

Prairie Star Family Practice, P.a.

  • Family Medicine Physician
  • Plainville, KS
National Provider Identifier
1003929001
Registry record updated Jun 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
04-28262 Issued in KS
Legal business name
PRAIRIE STAR FAMILY PRACTICE, P.A.
Practice address
1210 N. Washington, Clinic B
Plainville, KS 67663-1632
Phone
(785) 434-2622
Fax
(785) 434-2577
NPI assigned
Aug 16, 2006
Last updated
Jun 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Brull, M.D.NPI 1841303807
Title
Owner/President
Phone
(785) 434-2622

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 04-28262 KS Primary

Addresses

Primary practice location

1210 N. Washington, Clinic B
Plainville, KS 67663-1632

Mailing address

1210 N. Washington, Clinic B
P.O. Box 407
Plainville, KS 67663-0407
Phone (785) 434-2622

Other identifiers 4

IdentifierTypeStateIssuer
100376880CMedicaidKS
101898OtherKSBC/BS INDIVIDUAL
662541OtherKSFIRSTGUARD #
110760OtherKSBC/BS GROUP

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276560000000",
    "number": "1003929001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 N. WASHINGTON, CLINIC B",
            "address_2": "P.O. BOX 407",
            "city": "PLAINVILLE",
            "state": "KS",
            "postal_code": "676630407",
            "telephone_number": "785-434-2622",
            "fax_number": "785-434-2577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 N. WASHINGTON, CLINIC B",
            "city": "PLAINVILLE",
            "state": "KS",
            "postal_code": "676631632",
            "telephone_number": "785-434-2622",
            "fax_number": "785-434-2577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE STAR FAMILY PRACTICE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2010-06-15",
        "status": "A",
        "authorized_official_last_name": "BRULL",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "785-434-2622",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-28262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100376880C",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS INDIVIDUAL",
            "identifier": "101898",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTGUARD #",
            "identifier": "662541",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS GROUP",
            "identifier": "110760",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainville, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.