NPIMap

Individual provider Active NPI

Deborah Lockwood, PA-C

  • Physician Assistant
  • Shawnee, KS
National Provider Identifier
1174561237
Registry record updated Nov 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
15-01030 Issued in KS
Practice address
7405 Renner Rd
Ku Medwest
Shawnee, KS 66217-9414
Phone
(913) 588-8400
Fax
(913) 588-8413
NPI assigned
Jun 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 15-01030 KS Primary
Physician Assistant 363A00000X 117957 MO

Addresses

Primary practice location

7405 Renner Rd
Ku Medwest
Shawnee, KS 66217-9414

Mailing address

2330 Shawnee Mission Pkwy
Medical Administrative Services of Ku Med, Ste. 312
Westwood, KS 66205-2005
Phone (913) 588-9000

Other identifiers 3

IdentifierTypeStateIssuer
928367OtherFIRSTGUARD
200334360AMedicaidKS
481159444OtherJAYHAWK TAX ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15-01030KSMDPhysician Assistant
117957MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Jayhawk Primary Care Inc Past Accepting new patients
Jayhawk Primary Care Inc Past Accepting new patients
Jayhawk Primary Care Inc Past Accepting new patients
Jayhawk Primary Care Inc Past Accepting new patients
Jayhawk Primary Care Inc Past Accepting new patients
Jayhawk Primary Care Inc Past Accepting new patients
Jayhawk Primary Care Inc Past Accepting new patients
Jayhawk Primary Care Inc Past Accepting new patients
Jayhawk Primary Care Inc Past Accepting new patients

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258675200000",
    "number": "1174561237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 SHAWNEE MISSION PKWY",
            "address_2": "MEDICAL ADMINISTRATIVE SERVICES OF KU MED, STE. 312",
            "city": "WESTWOOD",
            "state": "KS",
            "postal_code": "662052005",
            "telephone_number": "913-588-9000",
            "fax_number": "913-588-9822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7405 RENNER RD",
            "address_2": "KU MEDWEST",
            "city": "SHAWNEE",
            "state": "KS",
            "postal_code": "662179414",
            "telephone_number": "913-588-8400",
            "fax_number": "913-588-8413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOCKWOOD",
        "first_name": "DEBORAH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-02",
        "last_updated": "2009-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-01030",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "117957",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTGUARD",
            "identifier": "928367",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200334360A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JAYHAWK TAX ID",
            "identifier": "481159444",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shawnee, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.