NPIMap

Organization Active NPI

Optum Medical Group PA

Doing business as Optum

  • Family Medicine Physician
  • Overland Park, KS
National Provider Identifier
1063143907
Registry record updated Oct 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
OPTUM MEDICAL GROUP PA
Doing business as
Optum
Practice address
6860 W 115TH St
Overland Park, KS 66211-2457
Phone
(913) 253-0601
NPI assigned
Jun 21, 2022
Last updated
Oct 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2026

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

Authorized official

Name
Jessica Aguilar
Title
Associate Director
Phone
(361) 585-5357

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

6860 W 115TH St
Overland Park, KS 66211-2457

Mailing address

PO Box 204783
Dallas, TX 75320-4783

Other names 1

  • Optum Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220928000391 KS Part B Supplier - Clinic/Group Practice 7214168111 Receives reassigned benefits from 15 practitioners
Practice locations: Overland Park, KS
O20220930000186 MO Part B Supplier - Clinic/Group Practice 7214168111 Receives reassigned benefits from 15 practitioners
Practice locations: Kansas City, MO

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

9229 Ward Pkwy
Kansas City, MO 64114
Phone (816) 444-5511

9229 Ward Pkwy
Ste 260
Kansas City, MO 64114
Phone (816) 289-2687

12921 S Vista Station Blvd
Fl 4
Draper, UT 84020
Phone (801) 963-6063

1403 E Sego Lily Dr
Ste 100
Sandy, UT 84092
Phone (385) 274-3959

Practitioners & affiliated clinicians

Practitioners 30

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 30

NPI Registry JSON

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

{
    "created_epoch": "1655769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791936000000",
    "number": "1063143907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 204783",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753204783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6860 W 115TH ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662112457",
            "telephone_number": "913-253-0601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUM MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-21",
        "last_updated": "2026-10-14",
        "certification_date": "2026-10-14",
        "status": "A",
        "authorized_official_last_name": "AGUILAR",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR",
        "authorized_official_telephone_number": "361-585-5357"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optum",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Optum",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Overland Park, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2026; 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.