Individual provider Active NPI

Emily Anne Fasbender, PT, DPT

  • Physical Therapist
  • Lee's Summit, MO
National Provider Identifier
1083360986
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2022031608 Issued in MO
Practice address
3747 SW Raintree Dr
Lees Summit, MO 64082-4606
Phone
(816) 537-5648
Fax
(816) 537-5649
NPI assigned
Mar 1, 2022
Last updated
Aug 10, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 11-06979 KS
Physical Therapist 225100000X 2022031608 MO Primary

Addresses

Primary practice location

3747 SW Raintree Dr
Lees Summit, MO 64082-4606

Mailing address

1200 Corporate Dr Ste 400
Hoover, AL 35242-5424
Phone (423) 238-7217

Other practice location 1

6640 Johnson Dr
Mission, KS 66202-2617
Phone (913) 384-5810

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220803002923 KS Practitioner - Physical Therapist in Private Practice 3779965009 Reassigns benefits to 1 organization
I20220812002263 MO Practitioner - Physical Therapist in Private Practice 3779965009 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Serc Rebabilitation Partners, LLCGroup PAC ID 9830344563, 212 clinicians

Practice addresses (Care Compare)

6640 Johnson Dr
Serc Mission
Mission, KS 66202-2617
Phone (913) 384-5810

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Serc Rebabilitation Partners, LLC Physical Therapist CurrentSince Aug 1, 2022 Accepting new patients
Serc Rehabilitation Partners, LLC Physical Therapist CurrentSince Aug 1, 2022 Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

13035 Kansas Ave
Bonner Springs, KS 66012
Phone (913) 721-6362

6640 Johnson Dr
Mission, KS 66202
Phone (913) 384-5600

1225 SW State Route 7
Blue Springs, MO 64014
Phone (816) 295-2051

109 W Franklin St
Clinton, MO 64735
Phone (660) 383-1280

3747 SW Raintree Dr
Lees Summit, MO 64082
Phone (816) 537-5648

Organizations & group practices 2

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": "1646092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1083360986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352425424",
            "telephone_number": "423-238-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3747 SW RAINTREE DR",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640824606",
            "telephone_number": "816-537-5648",
            "fax_number": "816-537-5649"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6640 Johnson Dr",
            "address_purpose": "LOCATION",
            "city": "Mission",
            "state": "KS",
            "postal_code": "662022617",
            "country_code": "US",
            "telephone_number": "913-384-5810",
            "fax_number": "913-384-0719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FASBENDER",
        "first_name": "EMILY",
        "middle_name": "ANNE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-01",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-06979",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2022031608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lee's Summit, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; 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.