NPIMap

Organization Active NPI

Dickson Diveley Midwest Orthopaedic Clinic LLC

  • Durable Medical Equipment & Medical Supplies
  • Overland Park, KS
National Provider Identifier
1164093589
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
DICKSON DIVELEY MIDWEST ORTHOPAEDIC CLINIC LLC
Practice address
10777 Nall Ave Ste 300
Overland Park, KS 66211-1330
Phone
(913) 642-0200
Fax
(913) 563-6699
NPI assigned
Jul 7, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Authorized official

Name
Jacob S Stueve
Title
Authorized Official
Phone
(913) 851-7780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

10777 Nall Ave Ste 300
Overland Park, KS 66211-1330

Mailing address

3651 College Blvd
Leawood, KS 66211-1910
Phone (913) 319-7600

Other names 1

  • Kansas City Orthopedic Alliance Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210917001696 KS DME Supplier - Physician - Orthopedic/Orthopedic Surgery 1153225479 Practice locations: Overland Park, KS

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Dickson Diveley Midwest Orthopaedic Clinic LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1164093589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3651 COLLEGE BLVD",
            "city": "LEAWOOD",
            "state": "KS",
            "postal_code": "662111910",
            "telephone_number": "913-319-7600",
            "fax_number": "913-253-1702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10777 NALL AVE STE 300",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111330",
            "telephone_number": "913-642-0200",
            "fax_number": "913-563-6699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKSON DIVELEY MIDWEST ORTHOPAEDIC CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-07",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "STUEVE",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "913-851-7780"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kansas City Orthopedic Alliance",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Overland Park, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.