Individual provider Active NPI

Otis S Latimer Sr., M.D.

  • Internal Medicine Physician
  • Kansas City, MO
National Provider Identifier
1033116058
Registry record updated Apr 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
102219 Issued in MO
Practice address
3801 Blue Pkwy
Kansas City, MO 64130-2807
Phone
(816) 923-5800
NPI assigned
Jul 5, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 102219 MO Primary

Addresses

Primary practice location

3801 Blue Pkwy
Kansas City, MO 64130-2807

Mailing address

5059 W 130TH Ter
Leawood, KS 66209-1861

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111203000173 MO Practitioner - Internal Medicine 1658280995 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wayne State University School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Swope Health ServicesGroup PAC ID 5294644530, 51 clinicians

Practice addresses (Care Compare)

17844 E 23Rd St S
Independence, MO 64057-1840
Phone (816) 257-9716

3801 Dr Martin Luther King Jr Blvd
Kansas City, MO 64130-2807
Phone (816) 923-5800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
102219MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Swope Health Services CurrentSince Sep 18, 2011 Accepting new patients
Swope Health Services CurrentSince Sep 18, 2011 Accepting new patients
Swope Health Services Past Accepting new patients

Locations

500 N Jesse James Rd
Excelsior Springs, MO 64024
Phone (816) 321-3240

17844 E 23rd St S
Independence, MO 64057
Phone (816) 257-9716

3801 Dr Martin Luther King Jr Blvd
Kansas City, MO 64130
Phone (816) 599-5500

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302825600000",
    "number": "1033116058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5059 W 130TH TER",
            "city": "LEAWOOD",
            "state": "KS",
            "postal_code": "662091861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 BLUE PKWY",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641302807",
            "telephone_number": "816-923-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATIMER",
        "first_name": "OTIS",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-05",
        "last_updated": "2011-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "102219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.