NPIMap

Organization Active NPI

Emergency Medicine Services of Mo, LLC

  • Emergency Medicine Physician
  • Independence, MO
National Provider Identifier
1023715182
Registry record updated Nov 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
EMERGENCY MEDICINE SERVICES OF MO, LLC
Practice address
19600 E 39TH St S
Independence, MO 64057-2301
Phone
(816) 698-7000
NPI assigned
Feb 9, 2023
Last updated
Nov 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2025

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

Authorized official

Name
Mr. Vyvyan Derouen
Title
President
Phone
(615) 376-5076

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

19600 E 39TH St S
Independence, MO 64057-2301

Mailing address

2000 Health Park Dr
Brentwood, TN 37027-4692
Phone (615) 373-7406

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230710001430 MO Part B Supplier - Clinic/Group Practice 1951766559 Receives reassigned benefits from 212 practitioners
Practice locations: Warrensburg, MO; Lexington, MO; Lees Summit, MO; Kansas City, MO; Independence, MO; Belton, MO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 225

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.

View all 225

NPI Registry JSON

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

{
    "created_epoch": "1675900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763596800000",
    "number": "1023715182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274692",
            "telephone_number": "615-373-7406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19600 E 39TH ST S",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640572301",
            "telephone_number": "816-698-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERGENCY MEDICINE SERVICES OF MO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-09",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A",
        "authorized_official_last_name": "DEROUEN",
        "authorized_official_first_name": "VYVYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-376-5076",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.