Individual provider Active NPI

Mary Rauth-Farley

  • Pediatrics Physician
  • Kansas City, MO
National Provider Identifier
1033520291
Registry record updated Nov 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
R1C65 Issued in MO
Practice address
5746 N Broadway St
Kansas City, MO 64118-3998
Phone
(816) 912-5439
Fax
(855) 813-6442
NPI assigned
May 9, 2014
Last updated
Nov 3, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2014

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0430385 KS
Family Medicine Physician 207Q00000X R1C65 MO
Pediatrics Physician 208000000X 0430385 KS
Pediatrics Physician 208000000X R1C65 MO Primary

Addresses

Primary practice location

5746 N Broadway St
Kansas City, MO 64118-3998

Mailing address

PO Box 1239
Troy, MI 48099-1239
Phone (248) 824-6600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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
I20150309000513 KS Practitioner - Pediatric Medicine 1759603004 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0430385KSMDPediatrics Physician
R1C65MOMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vpa PC Family Medicine CurrentSince Jan 26, 2015 Accepting new patients
Vpa PC Family Medicine Current Accepting new patients
Vpa PC Family Medicine PastSince Apr 28, 2024 Accepting new patients

Locations

9393 W 110th St
Ste 500
Overland Park, KS 66210
Phone (573) 234-1800

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1399593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414972800000",
    "number": "1033520291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1239",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480991239",
            "telephone_number": "248-824-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5746 N BROADWAY ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641183998",
            "telephone_number": "816-912-5439",
            "fax_number": "855-813-6442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAUTH-FARLEY",
        "first_name": "MARY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-09",
        "last_updated": "2014-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "0430385",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R1C65",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KS",
            "license": "0430385",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "R1C65",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.