Individual provider Active NPI

John H Hulsen III, MD

  • Plastic Surgery Physician
  • Leawood, KS
National Provider Identifier
1164738555
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
04-40029 Issued in KS
Practice address
11501 Granada St
Leawood, KS 66211-1454
Phone
(913) 451-3722
Fax
(913) 451-5000
NPI assigned
Aug 24, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 2017018138 MO
Plastic Surgery Physician 208200000X 04-40029 KS Primary

Addresses

Primary practice location

11501 Granada St
Leawood, KS 66211-1454

Mailing address

11501 Granada St
Leawood, KS 66211-1454
Phone (913) 451-3722

Other identifiers 2

IdentifierTypeStateIssuer
2017018138OtherMOMOBRHA
04-40029OtherKSKSBHA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200214002009 MO Practitioner - Plastic and Reconstructive Surgery 7911130737 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Southern Illinois University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Plastic Surgery Consultants, LTD.Group PAC ID 6901858968, 6 clinicians
Chesterfield Plastic and Reconstructive Surgery LLCGroup PAC ID 6608001573, 2 clinicians

Practice addresses (Care Compare)

10004 Kennerly Rd
Saint Louis, MO 63128-2109
Phone (314) 272-0864

111 Saint Lukes Ctr Dr
Suite 46B
Chesterfield, MO 63017-3509
Phone (314) 205-6420

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy17
Melanoma (skin cancer) excision1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
04-40029KSMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Plastic Surgery Consultants, LTD. Plastic Surgery CurrentSince Sep 1, 2025 Accepting new patients
Chesterfield Plastic & Reconstructive Surgery LLC Plastic Surgery CurrentSince Mar 1, 2020 Accepting new patients
St. Lukes Medical Group Plastic Surgery PastSince Mar 1, 2020 Accepting new patients
Cardiac Diagnostic Center LLC Past Accepting new patients

Locations

111 Saint Lukes Center Dr
Ste 46B
Chesterfield, MO 63017
Phone (314) 205-6420

10004 Kennerly Rd
Ste 281B
Saint Louis, MO 63128
Phone (314) 272-0864

10004 Kennerly Rd
Ste 283B
Saint Louis, MO 63128
Phone (314) 272-0864

232 S Woods Mill Rd
Town and Country, MO 63017
Phone (314) 205-6030

Organizations & group practices 4

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 1

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": "1282608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1164738555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11501 GRANADA ST",
            "city": "LEAWOOD",
            "state": "KS",
            "postal_code": "662111454",
            "telephone_number": "913-451-3722",
            "fax_number": "913-451-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11501 GRANADA ST",
            "city": "LEAWOOD",
            "state": "KS",
            "postal_code": "662111454",
            "telephone_number": "913-451-3722",
            "fax_number": "913-451-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HULSEN",
        "first_name": "JOHN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-24",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MO",
            "license": "2017018138",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "KS",
            "license": "04-40029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOBRHA",
            "identifier": "2017018138",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KSBHA",
            "identifier": "04-40029",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leawood, KS

Sources for this page

Verify at the official NPI Registry.