NPIMap

Individual provider Active NPI

Kenneth R Watson, DO

  • Anatomic Pathology & Clinical Pathology Physician
  • Kansas City, MO
National Provider Identifier
1114905221
Registry record updated Nov 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
R8692 Issued in MO
Practice address
10330 Hickman Mills Dr
Kansas City, MO 64137-1618
Phone
(816) 412-7004
Fax
(816) 763-7536
NPI assigned
Jan 9, 2006
Last updated
Nov 26, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 20A9489 CA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X R8692 MO Primary

Addresses

Primary practice location

10330 Hickman Mills Dr
Kansas City, MO 64137-1618

Mailing address

14275 Midway Rd
Suite 400
Addison, TX 75001-3614
Phone (214) 932-8029

Other identifiers 2

IdentifierTypeStateIssuer
241950005MedicaidKS
100229790AMedicaidKS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040602000116 MO Practitioner - Pathology 4789666090 Reassigns benefits to 2 organizations
I20070316000291 KS Practitioner - Pathology 4789666090 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mawd Pathology Group IncGroup PAC ID 2668421389, 38 clinicians
Mawd Pathologists LLCGroup PAC ID 5193102028, 28 clinicians

Practice addresses (Care Compare)

9100 W 74TH St
Adventhealth Shawnee Mission
Shawnee Mission, KS 66204-4004
Phone (913) 396-8509

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Creekwood Surgery Center, LP Current Accepting new patients
St. Luke's Hospital of Kansas City Past Accepting new patients
St Lukes Pathology Associates PA Anatomic Pathology & Clinical Pathology PastSince Jan 27, 1992 Accepting new patients

Locations

211 NE 54th St
Ste 100
Kansas City, MO 64118
Phone (816) 455-4214

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1136764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416960000000",
    "number": "1114905221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14275 MIDWAY RD",
            "address_2": "SUITE 400",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750013614",
            "telephone_number": "214-932-8029",
            "fax_number": "610-271-4245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10330 HICKMAN MILLS DR",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641371618",
            "telephone_number": "816-412-7004",
            "fax_number": "816-763-7536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "KENNETH",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-09",
        "last_updated": "2014-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "20A9489",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MO",
            "license": "R8692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "241950005",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100229790A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.