Carondelet Physician Services Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

35929 Issued in MO

Legal business name

CARONDELET PHYSICIAN SERVICES INC.

Practice address

220 NW Rd Mize Rd
Suite 101
Blue Springs, MO 64014-2527

Phone

(816) 228-9841

Fax

(816) 228-1514

NPI assigned

Nov 16, 2007

Organization subpart

Yes

Parent organization

CARONDELET HEALTHAs reported in NPPES

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

Authorized official

Name

Mr. Steven R Cleary

Title

Cfo

Phone

(816) 943-2819

Specialties & licenses 8

Addresses

Other identifiers 3

Part of

Carondelet Health

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Carondelet Health

  • General Acute Care Hospital
  • Kansas City, MO
  • NPI 1164401477
  NPPES parent name

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

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304640000000",
    "number": "1063693232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 NW SAINT MARY DR",
            "address_2": "SUITE 230",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640142524",
            "telephone_number": "816-655-5792",
            "fax_number": "816-655-5787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 NW RD MIZE RD",
            "address_2": "SUITE 101",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640142527",
            "telephone_number": "816-228-9841",
            "fax_number": "816-228-1514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARONDELET PHYSICIAN SERVICES INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CARONDELET HEALTH",
        "enumeration_date": "2007-11-16",
        "last_updated": "2011-05-06",
        "status": "A",
        "authorized_official_last_name": "CLEARY",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "816-943-2819",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "0431315",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "35929",
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MO",
            "license": "2006003132",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MO",
            "license": "R8H50",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MO",
            "license": "2004006974",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "MO",
            "license": "100628",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MO",
            "license": "2010008119",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "MO",
            "license": "R4B19",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200640420A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "39532013",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "501269500",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jayde Carlson
• Sarah Carollo, BCBA
• Carondelet Long Term Care Facilities, Inc.
• Carondelet Physician Services Inc
• Carondelet Physician Services Inc
• Carondelet Physician Services, Inc.
• Jamie Lyn Carver, LCSW
• Lacey Hillerman Case, NP
• Michelle Cass, APRN
• Alberto Ramon Castaneda, DDS FAGD

• Internal Medicine Physician in Blue Springs, MO
• Providers in Blue Springs, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.