NPIMap

Organization Active NPI

Cornerstone Dermatology & Surgery Group, PC

  • Procedural Dermatology Physician
  • Lee's Summit, MO
National Provider Identifier
1114427739
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
Legal business name
CORNERSTONE DERMATOLOGY & SURGERY GROUP, PC
Practice address
601 NW Obrien Rd
Lees Summit, MO 64063-1806
Phone
(816) 287-1528
NPI assigned
Feb 20, 2018
Last updated
Sep 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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

Authorized official

Name
David FielekeNPI 1679760417
Title
Credentialing Manager
Phone
(816) 287-1528

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Procedural Dermatology Physician 207NS0135X NU Primary

Addresses

Primary practice location

601 NW Obrien Rd
Lees Summit, MO 64063-1806

Mailing address

601 NW Obrien Rd
Lees Summit, MO 64063-1806
Phone (816) 287-1528

Other practice location 1

255 NW Blue Pkwy Ste 202
Lees Summit, MO 64063-1972
Phone (816) 287-1528

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180713000540 MO Part B Supplier - Clinic/Group Practice 3870856669 Receives reassigned benefits from 10 practitioners
Practice locations: Lees Summit, MO

National Provider Directory

National Provider Directory

Locations

255 NW Blue Pkwy
Ste 202
Lees Summit, MO 64063
Phone (816) 287-1528

601 NW Obrien Rd
Lees Summit, MO 64063
Phone (816) 287-1528

Practitioners & affiliated clinicians

Practitioners 11

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": "1519084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727395200000",
    "number": "1114427739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 NW OBRIEN RD",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640631806",
            "telephone_number": "816-287-1528",
            "fax_number": "343-503-0640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 NW OBRIEN RD",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640631806",
            "telephone_number": "816-287-1528"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "255 NW Blue Pkwy Ste 202",
            "address_purpose": "LOCATION",
            "city": "Lees Summit",
            "state": "MO",
            "postal_code": "640631972",
            "country_code": "US",
            "telephone_number": "816-287-1528",
            "fax_number": "343-503-0640",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CORNERSTONE DERMATOLOGY & SURGERY GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-20",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A",
        "authorized_official_last_name": "FIELEKE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "816-287-1528"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lee's Summit, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.