Individual provider Active NPI

Carl Dubose, M.D.

  • Psychiatry Physician
  • Kansas City, MO
National Provider Identifier
1114345840
Registry record updated Aug 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
2017014862 Issued in MO
Practice address
4400 Broadway Ste 407
Kansas City, MO 64111
Phone
(816) 931-1711
Fax
(816) 932-1719
NPI assigned
Mar 31, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 28, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X 2017014862 MO Primary

Addresses

Primary practice location

4400 Broadway Ste 407
Kansas City, MO 64111

Mailing address

901 E 104TH St
Mailstop 400S
Kansas City, MO 64131
Phone (816) 502-7117

Other practice location 1

1000 E 24th St
Kansas City, MO 64108-2776
Phone (816) 512-7481

Other practice location 2

1000 E 24th St
Kansas City, MO 64108-2776
Phone (816) 512-7481

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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 1

Enrollment IDStateProvider typePAC IDDetails
I20180621002768 MO Practitioner - Psychiatry 0244532075 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saint Lukes Physician Group IncGroup PAC ID 3577476894, 1,233 clinicians

Practice addresses (Care Compare)

4400 Broadway
Suite 505
Kansas City, MO 64111-3498
Phone (816) 932-4802

4400 Broadway
Suite 520
Kansas City, MO 64111-3342
Phone (816) 531-4080

4400 Broadway Blvd
Kansas City, MO 64111-3342

4400 Broadway Blvd
Suite 104
Kansas City, MO 64111-3498
Phone (816) 932-3100

4401 Wornall Rd
Kansas City, MO 64111-3220
Phone (816) 932-3100

601 S 169 Hwy
Smithville, MO 64089-9317
Phone (816) 532-3700

601 S US Hwy 169
Smithville, MO 64089-9317
Phone (816) 532-3999

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.56 of 100Reported as group
Quality
76.07
Promoting interoperability
100
Improvement activities
40
Cost
65.79

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2017014862MOMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Luke'S Physician Group Inc CurrentSince Jul 31, 2018 Accepting new patients
Saint Lukes Physician Group II LLC PastSince Aug 4, 2014 Accepting new patients

Locations

901 E 104th St
#400S
Kansas City, MO 64131
Phone (816) 502-7117

4400 Broadway Blvd
Ste 407
Kansas City, MO 64111
Phone (816) 931-1711

5844 NW Barry Rd
Ste 110
Kansas City, MO 64154
Phone (816) 880-6100

601 S US Highway 169
Smithville, MO 64089
Phone (816) 532-3999

Interoperability endpoints

  • Direct secure messaging: cdubose216856@direct.saint-lukes.org

Organizations & group practices 2

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": "1396224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535414400000",
    "number": "1114345840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 E 104TH ST",
            "address_2": "MAILSTOP 400S",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "64131",
            "telephone_number": "816-502-7117",
            "fax_number": "816-932-9670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 BROADWAY STE 407",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "64111",
            "telephone_number": "816-931-1711",
            "fax_number": "816-932-1719"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 E 24th St",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641082776",
            "country_code": "US",
            "telephone_number": "816-512-7481",
            "fax_number": "816-512-7486",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 E 24th St",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641082776",
            "country_code": "US",
            "telephone_number": "816-512-7481",
            "fax_number": "816-512-7486",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUBOSE",
        "first_name": "CARL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-03-31",
        "last_updated": "2018-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "2017014862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.