NPIMap

Organization Active NPI

KSP Health - Mo LLC

  • Family Medicine Physician
  • Harrisonville, MO
National Provider Identifier
1124871074
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KSP HEALTH - MO LLC
Practice address
117 S Lexington St Ste 100
Harrisonville, MO 64701-2444
Phone
(316) 516-2853
NPI assigned
Apr 10, 2024
Last updated
Apr 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

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

Authorized official

Name
Muthukumar Vellaichamy, MDNPI 1396778973
Title
Sole Member
Phone
(316) 516-2853

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

117 S Lexington St Ste 100
Harrisonville, MO 64701-2444

Mailing address

6446 E Central Ave Ste 183
Wichita, KS 67206-1923
Phone (316) 516-2853

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1712707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1124871074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6446 E CENTRAL AVE STE 183",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672061923",
            "telephone_number": "316-516-2853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 S LEXINGTON ST STE 100",
            "city": "HARRISONVILLE",
            "state": "MO",
            "postal_code": "647012444",
            "telephone_number": "316-516-2853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KSP HEALTH - MO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-10",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "VELLAICHAMY",
        "authorized_official_first_name": "MUTHUKUMAR",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "316-516-2853",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrisonville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.