NPIMap

Individual provider Active NPI

Constantine Paul Panakos, DO

  • Family Medicine Physician
  • Derby, KS
National Provider Identifier
1114949179
Registry record updated Apr 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0530413 Issued in KS
Practice address
606 N Mulberry Rd
Tanglewood Medical Center, PA
Derby, KS 67037-3532
Phone
(316) 788-3787
Fax
(316) 788-2618
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2015

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 0530413 KS Primary
Family Medicine Physician 207Q00000X 3867 IA

Addresses

Primary practice location

606 N Mulberry Rd
Tanglewood Medical Center, PA
Derby, KS 67037-3532

Mailing address

606 N Mulberry Rd
Tanglewood Medical Clinic, PA
Derby, KS 67037-3532
Phone (316) 788-3787

Other identifiers 2

IdentifierTypeStateIssuer
71590OtherBCBS
1114949179MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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
I20040603001326 KS Practitioner - Family Practice 4688656580 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tanglewood Family Medical Center PAGroup PAC ID 7113911389, 8 clinicians

Practice addresses (Care Compare)

606 N Mulberry Rd
Derby, KS 67037-3532
Phone (316) 788-3787

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3867IAMDFamily Medicine Physician
0530413KSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tanglewood Family Medical Center PA Family Medicine CurrentSince Feb 2, 2015 Accepting new patients
Central Kansas Emergency Physicians Past Accepting new patients

Locations

606 N Mulberry Rd
Derby, KS 67037
Phone (316) 262-5253

Interoperability endpoints

  • Direct secure messaging: constantine.panakos@tfmc.directbygreenway.com
  • Direct secure messaging: constantine.panakos@khindirect.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 6

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428278400000",
    "number": "1114949179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 N MULBERRY RD",
            "address_2": "TANGLEWOOD MEDICAL CLINIC, PA",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670373532",
            "telephone_number": "316-788-3787",
            "fax_number": "316-788-2618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 N MULBERRY RD",
            "address_2": "TANGLEWOOD MEDICAL CENTER, PA",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670373532",
            "telephone_number": "316-788-3787",
            "fax_number": "316-788-2618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANAKOS",
        "first_name": "CONSTANTINE",
        "middle_name": "PAUL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2015-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "0530413",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "3867",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "71590",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114949179",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Derby, KS

Sources for this page

Verify at the official NPI Registry.