Individual provider Active NPI

Shahram Mojahedi, CRNA

  • Certified Registered Nurse Anesthetist
  • Overland Park, KS
National Provider Identifier
1164689873
Registry record updated May 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
1383341041 Issued in KS
Practice address
12300 Metcalf Ave
Anesthesia Dept.
Overland Park, KS 66213-1324
Phone
(816) 389-6030
Fax
(816) 389-6034
NPI assigned
May 20, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 1383341041 KS Primary

Addresses

Primary practice location

12300 Metcalf Ave
Anesthesia Dept.
Overland Park, KS 66213-1324

Mailing address

9233 Ward Pkwy
Suite 230
Kansas City, MO 64114-3366
Phone (816) 389-6030

Other identifiers 2

IdentifierTypeStateIssuer
1383341041OtherKSKS RN LICENSE
2000169846OtherMOMO RN LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080918000286 KS Practitioner - Certified Registered Nurse Anesthetist (Crna) 2860569761 Reassigns benefits to 1 organization
I20191118000438 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 2860569761 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Lukes Physician Group IncGroup PAC ID 3577476894, 1,233 clinicians

Practice addresses (Care Compare)

1001 6TH Ave
Leavenworth, KS 66048-3248

12300 Metcalf Ave
Overland Park, KS 66213-1324
Phone (913) 317-7000

12330 Metcalf Ave
Overland Park, KS 66213-1324

4401 Wornall Rd
Kansas City, MO 64111-3220
Phone (816) 932-3100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.56 of 100Reported as group
Quality
76.07
Promoting interoperability
100
Improvement activities
40
Cost
65.79

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
1383341041KSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Luke'S Physician Group Inc Nurse Anesthetist, Certified Registered CurrentSince Nov 13, 2017 Accepting new patients
Gasgas LLC Nurse Anesthetist, Certified Registered Past Accepting new patients
Westport Anesthesia Services of Kansas PA Past Accepting new patients

Locations

711 Marshall St
Leavenworth, KS 66048
Phone (913) 684-1100

5405 W 151st St
Leawood, KS 66224
Phone (913) 323-8830

12330 Metcalf Ave
Ste 500A
Overland Park, KS 66213
Phone (913) 323-9000

12300 Metcalf Ave
Shawnee Mission, KS 66213
Phone (913) 317-7000

4401 Wornall Rd
Kansas City, MO 64111
Phone (816) 932-2107

901 E 104th St
Kansas City, MO 64131
Phone (816) 502-7117

901 E 104th St
#400N
Kansas City, MO 64131
Phone (816) 502-8756

601 S US Highway 169
Smithville, MO 64089
Phone (816) 532-3999

Organizations & group practices 3

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 4

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": "1211241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211241600000",
    "number": "1164689873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9233 WARD PKWY",
            "address_2": "SUITE 230",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641143366",
            "telephone_number": "816-389-6030",
            "fax_number": "816-389-6034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12300 METCALF AVE",
            "address_2": "ANESTHESIA DEPT.",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662131324",
            "telephone_number": "816-389-6030",
            "fax_number": "816-389-6034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOJAHEDI",
        "first_name": "SHAHRAM",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-20",
        "last_updated": "2008-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KS",
            "license": "1383341041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KS RN LICENSE",
            "identifier": "1383341041",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MO RN LICENSE",
            "identifier": "2000169846",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.