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Western Missouri Medical Center

Organization Active NPI Pediatrics Physician · Warrensburg, MO

NPI 1114306388 · NPPES record last updated May 7, 2021

Key facts

NPI
1114306388
Entity type
Organization (NPI type 2)
Primary specialty
Pediatrics Physician 208000000X
Legal business name
WESTERN MISSOURI MEDICAL CENTER
Practice address
510 Foster LN
Suite 201
Warrensburg, MO 64093-3213
Phone
(660) 262-7415
Fax
(660) 262-7416
NPI assigned
May 21, 2015
Organization subpart
No

Authorized official

Name
Michael Dean Ohmart
Title
Cfo
Phone
(660) 262-7307

Other NPIs on the same Medicare enrollment 18

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

Corporate family (same tax ID) 10

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 2

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

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2097523Building Blocks Pediatrics
510 Foster Lane Suite 201, Warrensburg, MO 64093		Certificate of waiverJun 16, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MO

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040616000777 MO Part B Supplier - Clinic/Group Practice 7416931506 Receives reassigned benefits from 138 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Warrensburg, MO

National Provider Directory

Tax ID family
Johnson County Mem Hosp (11 organizations share this tax ID)

Locations

510 Foster Ln
Ste 201
Warrensburg, MO 64093
Phone (660) 262-7415

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 208000000X Yes

Addresses

Primary practice location

510 Foster LN
Suite 201
Warrensburg, MO 64093-3213

Mailing address

510 Foster LN
Suite 201
Warrensburg, MO 64093-3213
Phone (660) 262-7415

Other names

  • Building Blocks Pediatrics Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 7, 2021.

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620345600000",
    "number": "1114306388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 FOSTER LN",
            "address_2": "SUITE 201",
            "city": "WARRENSBURG",
            "state": "MO",
            "postal_code": "640933213",
            "telephone_number": "660-262-7415",
            "fax_number": "660-262-7416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 FOSTER LN",
            "address_2": "SUITE 201",
            "city": "WARRENSBURG",
            "state": "MO",
            "postal_code": "640933213",
            "telephone_number": "660-262-7415",
            "fax_number": "660-262-7416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN MISSOURI MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-21",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A",
        "authorized_official_last_name": "OHMART",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "660-262-7307"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Building Blocks Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Building Blocks Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warrensburg, MO

All providers in Warrensburg, MO · Pediatrics Physician in Missouri

Sources for this page

Verify at the official NPI Registry.