Martha Sue Fanning, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

04-26640 Issued in KS

Practice address

12300 Metcalf Ave
Overland Park, KS 66213-1324

Phone

(913) 317-7485

NPI assigned

Aug 3, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 8

Other names 1

• Martha Sue Pack Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Saint Luke'S South Hospital Inc.

  • Renal Nutrition Registered Dietitian
  • Overland Park, KS
  • NPI 1669606737
  NPD (past)
• Shawnee Mission Medical Center

  • Emergency Medical Services (Emergency Medicine) Physician
  • Shawnee Mission, KS
  • NPI 1598970790
  NPD (past)
• United Imaging Consultants, LLC

  • Diagnostic Radiology Physician
  • Lenexa, KS
  • NPI 1588669766
  NPD (past)

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1073514733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 411039",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641411039",
            "telephone_number": "913-234-1350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12300 METCALF AVE",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662131324",
            "telephone_number": "913-317-7485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANNING",
        "first_name": "MARTHA",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-03",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KS",
            "license": "04-26640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100333210C",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS KC MO",
            "identifier": "24548088",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS KC MO GRP 01674018",
            "identifier": "01674018",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100333210E",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS KC MO",
            "identifier": "24548068",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP DC6712",
            "identifier": "P00278183",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208531038",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP CC8899",
            "identifier": "930072754",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARTHA",
            "last_name": "PACK",
            "middle_name": "SUE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Family Health Group, Inc
• Family Health Medical Group of Overland Park, LLC
• Tyler Fancher, PA-C
• Whitney Blaire Fancher, M.D.
• Jacob John Fanders, D.C.
• Stephen Fanous
• Kimberly A Farag, LPC
• Ghina Fares
• Chelsea Lynn Farmer, LMSW
• Rachel Farmer

• Emergency Medicine Physician in Overland Park, KS
• Providers in Overland Park, KS by specialty
• Emergency Medicine Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; 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.