NPIMap

Individual provider Active NPI

Crystal Brown-Vredenburg

  • Family Medicine Physician
  • Lees Summit, MO
National Provider Identifier
1114488665
Registry record updated Oct 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2022033075 Issued in MO
Practice address
20 NE Saint Lukes Blvd Ste 200
Lees Summit, MO 64086-6001
Phone
(816) 347-5100
Fax
(816) 347-5136
NPI assigned
Mar 27, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X TBD MO
Family Medicine Physician 207Q00000X 2022033075 MO Primary

Addresses

Primary practice location

20 NE Saint Lukes Blvd Ste 200
Lees Summit, MO 64086-6001

Mailing address

20 NE Saint Lukes Blvd Ste 200
Lees Summit, MO 64086-6001
Phone (816) 347-5100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220930001353 MO Practitioner - Family Practice 8325373095 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kansas School of Med (KC/Wich/Sal), 2019
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
Ability KCGroup PAC ID 0143116368, 166 clinicians

Practice addresses (Care Compare)

20 NE Saint Lukes Blvd
Suite 200
Lees Summit, MO 64086-6001
Phone (816) 347-5100

3011 Baltimore Ave
Kansas City, MO 64108-3403
Phone (816) 751-7832

Hospital & facility affiliations

  • Saint Lukes Home Care Home health agency, Kansas City, MO, CCN 267195
  • Phoenix Home Care Home health agency, Independence, MO, CCN 267650
  • St Lukes Hospital of Kansas City Hospital, Kansas City, MO, CCN 260138
  • Saint Luke'S East Hospital Hospital, Lees Summit, MO, CCN 260216
  • Centerpoint Medical Center Hospital, Independence, MO, CCN 260095
  • Lee'S Summit Medical Center Hospital, Lees Summit, MO, CCN 260190

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2022033075MOMDFamily Medicine Physician
TBDMOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Luke'S Physician Group Inc Family Medicine CurrentSince Aug 29, 2022 Accepting new patients

Locations

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

20 NE Saint Lukes Blvd
Ste 200
Lees Summit, MO 64086
Phone (816) 347-5100

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

Interoperability endpoints

  • Direct secure messaging: cbrownvredenburg404251@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 8

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": "1553644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667174400000",
    "number": "1114488665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 NE SAINT LUKES BLVD STE 200",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640866001",
            "telephone_number": "816-347-5100",
            "fax_number": "816-347-5136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 NE SAINT LUKES BLVD STE 200",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640866001",
            "telephone_number": "816-347-5100",
            "fax_number": "816-347-5136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN-VREDENBURG",
        "first_name": "CRYSTAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-27",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "TBD",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2022033075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lees Summit, MO

Sources for this page

Verify at the official NPI Registry.