NPIMap

Organization Active NPI

Centerwell Senior Primary Care KS PA

  • Internal Medicine Physician
  • Kansas City, KS
National Provider Identifier
1104347756
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CENTERWELL SENIOR PRIMARY CARE KS PA
Practice address
7527 State Ave
Kansas City, KS 66112-2815
Phone
(913) 335-6986
Fax
(855) 446-7151
NPI assigned
Jul 5, 2017
Organization subpart
Yes
Parent organization
CENTERWELL SENIOR PRIMARY CARE KS PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Authorized official

Name
Angie Martinez
Title
Senior Credentialing Professional
Phone
(407) 447-7120

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

Primary practice location

7527 State Ave
Kansas City, KS 66112-2815

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (305) 500-2000

Other names 4

  • CenterWell Senior Primary Care- State Avenue Doing business as
  • Partners in Primary Care- State Avenue Doing business as
  • Partners in Primary Care TX PA Former legal business name
  • Partners inPrimary Care (KS), P.A. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200721000723 KS Part B Supplier - Clinic/Group Practice 6002230349 Receives reassigned benefits from 40 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Olathe, KS; Overland Park, KS; Wichita, KS; Kansas City, KS

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D2136731Centerwell Senior Primary Care-State Avenue7527 State Ave, Kansas City, KS 66112Certificate of waiverSep 13, 2027

National Provider Directory

National Provider Directory
Tax ID family
Centerwell Senior Primary Care KS PA4 organizations share this tax ID, including this one
Part of
Centerwell Senior Primary Care KS PA

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7527 State Ave
Kansas City, KS 66112
Phone (913) 335-6986

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1499212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1104347756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7527 STATE AVE",
            "city": "KANSAS CITY",
            "state": "KS",
            "postal_code": "661122815",
            "telephone_number": "913-335-6986",
            "fax_number": "855-446-7151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERWELL SENIOR PRIMARY CARE KS PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTERWELL SENIOR PRIMARY CARE KS PA",
        "enumeration_date": "2017-07-05",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "SENIOR CREDENTIALING PROFESSIONAL",
        "authorized_official_telephone_number": "407-447-7120"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CenterWell Senior Primary Care- State Avenue",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Partners in Primary Care- State Avenue",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Partners in Primary Care TX PA",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Partners inPrimary Care (KS), P.A.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Kansas City, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; 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.