Individual provider Active NPI

Abbie Mae Obrien, PA

  • Physician Assistant
  • Independence, MO
National Provider Identifier
1083171292
Registry record updated Aug 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2019003331 Issued in MO
Practice address
17525 Medical Center Pkwy
Independence, MO 64057-1824
Phone
(816) 994-3150
Fax
(816) 359-3044
NPI assigned
Feb 24, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2019003331 MO Primary

Addresses

Primary practice location

17525 Medical Center Pkwy
Independence, MO 64057-1824

Mailing address

8551 Bluejacket St
Lenexa, KS 66214-1656
Phone (913) 981-1215

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 enrollments
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190312001207 MO Practitioner - Physician Assistant 6204175185 Reassigns benefits to 1 organization
I20200817002558 KS Practitioner - Physician Assistant 6204175185 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2019003331MOMDPhysician Assistant

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1550966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565308800000",
    "number": "1083171292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8551 BLUEJACKET ST",
            "city": "LENEXA",
            "state": "KS",
            "postal_code": "662141656",
            "telephone_number": "913-981-1215",
            "fax_number": "913-439-4823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17525 MEDICAL CENTER PKWY",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640571824",
            "telephone_number": "816-994-3150",
            "fax_number": "816-359-3044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBRIEN",
        "first_name": "ABBIE",
        "middle_name": "MAE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-24",
        "last_updated": "2019-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2019003331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, MO

Sources for this page

Verify at the official NPI Registry.