NPIMap

Organization Active NPI

Midwest Aortic & Vascular Institute, P.C.

  • Vascular Surgery Physician
  • North Kansas City, MO
National Provider Identifier
1164476339
Registry record updated Mar 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
MIDWEST AORTIC & VASCULAR INSTITUTE, P.C.
Practice address
2750 Clay Edwards Drive
Suite 304
North Kansas City, MO 64116
Phone
(816) 842-5555
Fax
(816) 659-9123
NPI assigned
May 20, 2006
Last updated
Mar 10, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2016

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

Authorized official

Name
Annette Small
Title
Chief Executive Officer
Phone
(816) 872-1601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X NU Primary

Addresses

Primary practice location

2750 Clay Edwards Drive
Suite 304
North Kansas City, MO 64116

Mailing address

2750 Clay Edwards Drive
Suite 304
North Kansas City, MO 64116
Phone (816) 842-5555

Other names 1

  • Kansas City Vascular, P.C. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060629000119 MO Part B Supplier - Clinic/Group Practice 7911919360 Receives reassigned benefits from 12 practitioners
Practice locations: Independence, MO; Lees Summit, MO; Liberty, MO; North Kansas City, MO

National Provider Directory

National Provider Directory

Locations

2100 SE Blue Pkwy
Ste 120
Lees Summit, MO 64063
Phone (816) 842-5555

2521 Glenn Hendren Dr
Ste 112
Liberty, MO 64068
Phone (816) 781-5006

2750 Clay Edwards Dr
Ste 140
North Kansas City, MO 64116
Phone (816) 842-5555

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1811/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 12

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": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457568000000",
    "number": "1164476339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 CLAY EDWARDS DRIVE",
            "address_2": "SUITE 304",
            "city": "NORTH KANSAS CITY",
            "state": "MO",
            "postal_code": "64116",
            "telephone_number": "816-842-5555",
            "fax_number": "816-659-9123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 CLAY EDWARDS DRIVE",
            "address_2": "SUITE 304",
            "city": "NORTH KANSAS CITY",
            "state": "MO",
            "postal_code": "64116",
            "telephone_number": "816-842-5555",
            "fax_number": "816-659-9123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST AORTIC & VASCULAR INSTITUTE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2016-03-10",
        "status": "A",
        "authorized_official_last_name": "SMALL",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "816-872-1601"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kansas City Vascular, P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in North Kansas City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2016; 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.