Allen Bruce Jetmore, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

0424436 Issued in KS

Practice address

11111 Nall Ave
Suite 116
Leawood, KS 66211-1924

Phone

(913) 451-0600

Fax

(913) 451-0601

NPI assigned

Aug 9, 2006

Sex

Male

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 1

Medicare fee-for-service enrollment

Enrolled in MO, KS, WI3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Colorectal Surgery (Proctology)Also: General Surgery

Education

Duke University School of Medicine, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Midwest Hemorrhoid Treatment Center LLCGroup PAC ID 9133122245, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Overland Park Reg Med Ctr Hospital, Overland Park, KS, CCN 170176
• St Joseph Medical Center Hospital, Kansas City, MO, CCN 260085
• Menorah Medical Center Hospital, Overland Park, KS, CCN 170182
• Adventhealth Shawnee Mission Hospital, Shawnee Mission, KS, CCN 170104

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/8F7ruIta-JA7ecm4ommy-Q50dF1FkFe4/

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.

• Ab Jetmore MD LLC

  • Colon & Rectal Surgery Physician
  • Lenexa, KS
  • NPI 1114258886

  MO

  Medicare reassignment NPD Authorized official
• Midwest Hemorrhoid Treatment Center LLC

  • Specialist
  • Leawood, KS
  • NPI 1538106448
  Medicare reassignment Care Compare group NPD
• Fort Healthcare Inc

  • Otolaryngology Physician
  • Fort Atkinson, WI
  • NPI 1417993361
  Medicare reassignment NPD
• Fort Healthcare Inc

  • Rural Health Clinic/Center
  • Fort Atkinson, WI
  • NPI 1417450115
  NPD
• Complete Health Care Services PA

  • Geriatric Medicine (Family Medicine) Physician
  • Leawood, KS
  • NPI 1427350248
  NPD (past)
• Menorah Medical Group, LLC

  • Internal Medicine Physician
  • Overland Park, KS
  • NPI 1386957223
  NPD (past)
• Carondelet Physician Services, Inc.

  • Family Medicine Physician
  • Grain Valley, MO
  • NPI 1699040006
  NPD (past)
• Colon and Rectal Surgeons of Kansas City, P.a.

  • Specialist
  • North Kansas City, MO
  • NPI 1174744908
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Midwest Division - MMC, LLC

  dba Menorah Medical Center

  • General Acute Care Hospital
  • Overland Park, KS
  • NPI 1255378337
  Care Compare affiliation
• Midwest Division-Oprmc LLC

  dba Overland Park Regional Medical Center

  • General Acute Care Hospital
  • Overland Park, KS
  • NPI 1578500484
  Care Compare affiliation
• Shawnee Mission Medical Center Inc

  dba AdventHealth Shawnee Mission

  • General Acute Care Hospital
  • Merriam, KS
  • NPI 1023171634
  Care Compare affiliation
• Shawnee Mission Medical Center Inc

  • Clinical Medical Laboratory
  • Merriam, KS
  • NPI 1235792003

  Hospital

  Care Compare affiliation
• Prime Healthcare Services - Kansas City, LLC

  dba St. Joseph Medical Center

  • General Acute Care Hospital
  • Kansas City, MO
  • NPI 1528463080
  Care Compare affiliation

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314576000000",
    "number": "1093725111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11111 NALL AVE",
            "address_2": "SUITE 116",
            "city": "LEAWOOD",
            "state": "KS",
            "postal_code": "662111924",
            "telephone_number": "913-451-0600",
            "fax_number": "913-451-0601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11111 NALL AVE",
            "address_2": "SUITE 116",
            "city": "LEAWOOD",
            "state": "KS",
            "postal_code": "662111924",
            "telephone_number": "913-451-0600",
            "fax_number": "913-451-0601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JETMORE",
        "first_name": "ALLEN",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2011-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "KS",
            "license": "0424436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KANSAS CITY",
            "identifier": "18198056",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Loretta A. Jasper, LCPC
• Diamond Jean Baptiste, FNP-C
• Jeff Thompson Orthodontics
• Andrew James Jefferson, MD
• Jessica Thompson
• Jiomed Family Care LLC
• John L'Ecuyer, MD, LLC
• Robert A Johns, D.D.S.
• Darryl Johnson
• Rachel Lynn Johnson, OTR/L

• Specialist in Leawood, KS
• Providers in Leawood, KS by specialty
• Specialist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.