Individual provider Active NPI

David Vaughn Porter Jr., PA-C

  • Medical Physician Assistant
  • Merriam, KS
National Provider Identifier
1154831642
Registry record updated Jul 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
15-03060 Issued in KS
Practice address
7450 Kessler St Ste 202
Merriam, KS 66204-2553
Phone
(913) 632-9480
Fax
(913) 632-9499
NPI assigned
Oct 10, 2017
Last updated
Jul 2, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2017036354 MO
Medical Physician Assistant 363AM0700X 15-03060 KS Primary

Addresses

Primary practice location

7450 Kessler St Ste 202
Merriam, KS 66204-2553

Mailing address

7450 Kessler St Ste 202
Merriam, KS 66204-2553
Phone (913) 632-9480

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251112002945 KS Practitioner - Physician Assistant 5698033231 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

9100 W 74TH St
Ahmg Psychiatry at Shawnee Mission
Merriam, KS 66204-4004
Phone (913) 632-2642

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
15-03060KSMDMedical Physician Assistant
2017036354MOMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Shawnee Mission Medical Center Inc Medical CurrentSince Aug 30, 2025 Accepting new patients

Locations

9301 W 74th St
Ste 100
Shawnee Mission, KS 66204
Phone (913) 632-9100

7450 Kessler St
Ste 202
Shawnee Msn, KS 66204
Phone (913) 632-9480

9100 W 74th St
Shawnee Msn, KS 66204
Phone (913) 632-2230

Interoperability endpoints

  • Direct secure messaging: dporter5093438@adventhealth.direct-ci.com

Organizations & group practices 1

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 5

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": "1507593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751414400000",
    "number": "1154831642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7450 KESSLER ST STE 202",
            "city": "MERRIAM",
            "state": "KS",
            "postal_code": "662042553",
            "telephone_number": "913-632-9480",
            "fax_number": "913-632-9499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7450 KESSLER ST STE 202",
            "city": "MERRIAM",
            "state": "KS",
            "postal_code": "662042553",
            "telephone_number": "913-632-9480",
            "fax_number": "913-632-9499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "DAVID",
        "middle_name": "VAUGHN",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-10",
        "last_updated": "2025-07-02",
        "certification_date": "2025-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MO",
            "license": "2017036354",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KS",
            "license": "15-03060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merriam, KS

Sources for this page

Verify at the official NPI Registry.