Individual provider Active NPI

Irvin Ramos-Bencomo, DPT

  • Physical Therapist
  • Lenexa, KS
National Provider Identifier
1063289585
Registry record updated Dec 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11-07485 Issued in KS
Practice address
23351 Prairie Star Pkwy Ste A125
Lenexa, KS 66227-7303
Phone
(913) 676-8610
NPI assigned
Dec 5, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physical Therapist 2251S0007X
Orthopedic Physical Therapist 2251X0800X
Physical Therapist 225100000X 11-07485 KS Primary

Addresses

Primary practice location

23351 Prairie Star Pkwy Ste A125
Lenexa, KS 66227-7303

Mailing address

304 SW 4TH St
Newton, KS 67114-3624

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260109003291 KS Practitioner - Physical Therapist in Private Practice 6406332386 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
University of Kansas School of Med (KC/Wich/Sal), 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northland Physical Therapy and Rehab Services IncGroup PAC ID 1850370453, 120 clinicians

Practice addresses (Care Compare)

5600 Hedge Lane Ter
Shawnee, KS 66226-2255
Phone (816) 474-8877

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11-07485KSMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Northland Physical Therapy & Rehab Services, Inc Physical Therapist CurrentSince Jan 1, 2026 Accepting new patients
Shawnee Mission Medical Center, Inc. PastSince Dec 10, 2023 Accepting new patients
Dickson Diveley Midwest Orthopaedic Clinic LLC Past Accepting new patients

Locations

15445 Metcalf Ave
Overland Park, KS 66223
Phone (913) 232-8955

5600 Hedge Lane Ter
Shawnee, KS 66226
Phone (913) 322-4100

2100 Swift Ave
North Kansas City, MO 64116
Phone (816) 474-8877

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": "1701734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701734400000",
    "number": "1063289585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 SW 4TH ST",
            "city": "NEWTON",
            "state": "KS",
            "postal_code": "671143624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23351 PRAIRIE STAR PKWY STE A125",
            "city": "LENEXA",
            "state": "KS",
            "postal_code": "662277303",
            "telephone_number": "913-676-8610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAMOS-BENCOMO",
        "first_name": "IRVIN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-05",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-07485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lenexa, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.