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

Last updated

Jun 29, 2021By the provider in NPPES

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 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Saint Luke's South Hospital Inc.

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

  dba SMMC Emergency Physicians

  • 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": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARTHA",
            "last_name": "PACK",
            "middle_name": "SUE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Family Health Medical Group of Overland Park, LLC
• Jonathon Lee Fancher, LPC
• 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.