NPIMap

Organization Active NPI

Northland Gastroenterology

  • Gastroenterology Physician
  • Excelsior Springs, MO
National Provider Identifier
1093884504
Registry record updated Jul 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
R9779 Issued in MO
Legal business name
NORTHLAND GASTROENTEROLOGY
Practice address
1345 N Jesse James Rd
Excelsior Springs, MO 64024-1183
Phone
(816) 630-0900
Fax
(816) 637-3250
NPI assigned
Nov 7, 2006
Last updated
Jul 8, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2008

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

Authorized official

Name
Ms. Brandi E Potter
Title
Billing
Phone
(816) 554-3838

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X R9779 MO Primary

Addresses

Primary practice location

1345 N Jesse James Rd
Excelsior Springs, MO 64024-1183

Mailing address

1345 N Jesse James Rd
Excelsior Springs, MO 64024-1183
Phone (816) 630-0900

Other identifiers 1

IdentifierTypeStateIssuer
09040299OtherMOBCBS

National Provider Directory

National Provider Directory

Locations

20 NE Saint Lukes Blvd
Ste 330
Lees Summit, MO 64086
Phone (816) 347-4420

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215475200000",
    "number": "1093884504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1345 N JESSE JAMES RD",
            "city": "EXCELSIOR SPRINGS",
            "state": "MO",
            "postal_code": "640241183",
            "telephone_number": "816-630-0900",
            "fax_number": "816-637-3250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 N JESSE JAMES RD",
            "city": "EXCELSIOR SPRINGS",
            "state": "MO",
            "postal_code": "640241183",
            "telephone_number": "816-630-0900",
            "fax_number": "816-637-3250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAND GASTROENTEROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2008-07-08",
        "status": "A",
        "authorized_official_last_name": "POTTER",
        "authorized_official_first_name": "BRANDI",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "816-554-3838",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MO",
            "license": "R9779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "09040299",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Excelsior Springs, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2008; 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.