NPIMap

Individual provider Active NPI

Ethan Steed Jaeger, DO

  • Sports Medicine (Family Medicine) Physician
  • Overland Park, KS
National Provider Identifier
1104319748
Registry record updated Jul 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
05-46502 Issued in KS
Practice address
10730 Nall Ave Ste 200
Overland Park, KS 66211-1285
Phone
(913) 588-1227
NPI assigned
Jun 8, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 05-46502 KS Primary

Addresses

Primary practice location

10730 Nall Ave Ste 200
Overland Park, KS 66211-1285

Mailing address

10730 Nall Ave Ste 20010730
Overland Park, KS 66211-1366
Phone (913) 588-1227

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210408000113 MO Practitioner - Family Practice 6002161742 Reassigns benefits to 1 organization
I20220815001831 KS Practitioner - Family Practice 6002161742 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jayhawk Primary Care IncGroup PAC ID 8123928900, 157 clinicians
Kansas University Physicians IncGroup PAC ID 8921911587, 1,809 clinicians

Practice addresses (Care Compare)

7405 Renner Rd
Shawnee, KS 66217-9414
Phone (913) 588-8400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
General John J Pershing Memorial Hospital Association CurrentSince Jun 1, 2021 Accepting new patients
Jayhawk Primary Care Inc Family Medicine CurrentSince Aug 1, 2022 Accepting new patients
Kansas University Physicians Inc CurrentSince Aug 1, 2022 Accepting new patients
Kansas University Physicians, Inc. Family Medicine CurrentSince Aug 1, 2022 Accepting new patients
General John J Pershing Memorial Hospital Association CurrentSince Jun 1, 2021 Accepting new patients
Kansas University Physicians Inc Family Medicine Current Accepting new patients
Jayhawk Primary Care Inc Family Medicine CurrentSince Aug 1, 2022 Accepting new patients
Jayhawk Primary Care Inc Family Medicine Past Accepting new patients
Kansas University Physicians Inc Past Accepting new patients

Locations

3901 Rainbow Blvd
Kansas City, KS 66160
Phone (913) 588-6005

4000 Cambridge St
Kansas City, KS 66160
Phone (913) 588-0000

11300 Corporate Ave
Ste 342
Lenexa, KS 66219
Phone (913) 574-0425

10730 Nall Ave
Ste 200
Overland Park, KS 66211
Phone (913) 574-1460

10730 Nall Ave
Ste 20010730
Overland Park, KS 66211

10700 Nall Ave
Ste 101
Overland Park, KS 66211

7405 Renner Rd
Shawnee Msn, KS 66217
Phone (913) 588-2200

130 E Lockling St
Brookfield, MO 64628
Phone (660) 258-1050

Interoperability endpoints

  • Direct secure messaging: ejaeger699194@direct.kuha.org

Organizations & group practices 9

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1528416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1104319748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10730 NALL AVE STE 20010730",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111366",
            "telephone_number": "913-588-1227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10730 NALL AVE STE 200",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111285",
            "telephone_number": "913-588-1227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAEGER",
        "first_name": "ETHAN",
        "middle_name": "STEED",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-08",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "KS",
            "license": "05-46502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

Verify at the official NPI Registry.