Element Physical Medicine, LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

2010035953 Issued in MO

Legal business name

ELEMENT PHYSICAL MEDICINE, LLC

Practice address

601 E. 63Rd Street
Suite 210
Kansas City, MO 64110-3303

Phone

(816) 924-9475

NPI assigned

Jun 2, 2011

Organization subpart

No

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

Authorized official

Name

Kelly J Logan, DO

Title

Owner

Phone

(816) 924-9475

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1306972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462406400000",
    "number": "1205120649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16861",
            "city": "RAYTOWN",
            "state": "MO",
            "postal_code": "641339998",
            "telephone_number": "816-924-9475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E. 63RD STREET",
            "address_2": "SUITE 210",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641103303",
            "telephone_number": "816-924-9475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEMENT PHYSICAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-02",
        "last_updated": "2016-05-05",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "816-924-9475",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MO",
            "license": "2010035953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2016; 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.