Jason H Mildenberger, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2018011301 Issued in MO

Practice address

2800 Clay Edwards Dr
North Kansas City, MO 64116

Phone

(816) 691-2000

NPI assigned

Sep 27, 2013

Sex

Male

Sole proprietor

No

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.

• Liberty Hospital Emergency Medicine Physicians, LLC

  • Emergency Medicine Physician
  • Liberty, MO
  • NPI 1336646736

  MO

  Medicare reassignment
• Midwest Emergency Medical Services PC

  • Emergency Medicine Physician
  • North Kansas City, MO
  • NPI 1578556023

  MO

  Medicare reassignment
• Coweta Emergency Group LLC

  • Emergency Medicine Physician
  • Newnan, GA
  • NPI 1245556588

  GA

  Medicare reassignment
• Georgia Emergency Group, LLC

  • Emergency Medicine Physician
  • Griffin, GA
  • NPI 1952746638

  GA

  Medicare reassignment
• VA Eastern Kansas Health Care System

  • Emergency Medicine Physician
  • Leavenworth, KS
  • NPI 1255432951

  MO

  Medicare reassignment
• LPP of Missouri LLC

  • Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
  • Blue Springs, MO
  • NPI 1356879563
  NPD (past)
• New Liberty Hospital Coporation

  • Emergency Medicine Physician
  • Liberty, MO
  • NPI 1245054295
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in GA, MO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 17, 2018.

{
    "created_epoch": "1380240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531785600000",
    "number": "1053748616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5665 NEW NORTHSIDE DR",
            "address_2": "SUITE 320",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303285831",
            "telephone_number": "770-874-5468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 CLAY EDWARDS DR",
            "city": "NORTH KANSAS CITY",
            "state": "MO",
            "postal_code": "64116",
            "telephone_number": "816-691-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "303 Parkway Dr NE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303121212",
            "country_code": "US",
            "telephone_number": "404-265-4327",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILDENBERGER",
        "first_name": "JASON",
        "middle_name": "H",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-27",
        "last_updated": "2018-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "007036",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2018011301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Midwest Aortic & Vascular Institute, P.C.
• Midwest Emergency Medical Services PC
• Midwest Hemorrhoid Treatment Center North Kansas City LLC
• Neil V Mikel, M.D.
• Kelly Mikle, OTR/L, CHT
• John T Miller, MD
• Kristen Marie Miller, CRNA
• Morgan Miller, M.S., CCC-SLP
• Sara J Miller, FNP - BC
• Richard Ainsworth Mills, M.D.

• All providers in North Kansas City, MO
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.