NPIMap

Individual provider Active NPI

Fred A Church, D.O.

  • Family Medicine Physician
  • Olathe, KS
National Provider Identifier
1215924600
Registry record updated Jan 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0528541 Issued in KS
Practice address
11164 S Noble Dr
Olathe, KS 66061-7572
Phone
(913) 829-2440
Fax
(913) 338-1311
NPI assigned
Sep 30, 2005
Last updated
Jan 31, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0528541 KS Primary

Addresses

Primary practice location

11164 S Noble Dr
Olathe, KS 66061-7572

Mailing address

PO Box 741331
Atlanta, GA 30374-1331
Phone (913) 469-0503

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address fred.church@cpfc.eclinicaldirectplus.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100609000065 KS Practitioner - Family PracticePractitioner - General Practice 8729118351 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Overland Park Surgical Specialties LLCGroup PAC ID 9234318502, 86 clinicians

Practice addresses (Care Compare)

10500 Quivira Rd
Overland Park, KS 66215-2306
Phone (913) 541-5000

10600 Mastin St
Overland Park, KS 66212-5723

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.84 of 100Reported as group
Quality
78.92
Promoting interoperability
99
Improvement activities
40
Cost
71.37

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
College Park Family Care Center PA Family Medicine Current Accepting new patients
Overland Park Surgical Specialties LLC Family Medicine CurrentSince Jan 1, 2013 Accepting new patients
Mercy Medical Center Past Accepting new patients
College Park Family Care Center, P.a. Past Accepting new patients

Locations

11164 S Noble Dr
Olathe, KS 66061
Phone (913) 469-6447

20333 W 151st St
Olathe, KS 66061
Phone (888) 960-1393

10100 W 119th St
Ste 150
Overland Park, KS 66213
Phone (913) 469-8878

11725 W 112th St
Overland Park, KS 66210
Phone (913) 469-5452

11755 W 112th St
Ste 101
Overland Park, KS 66210
Phone (913) 469-0503

11755 W 112th St
Ste 202
Overland Park, KS 66210
Phone (913) 469-0433

10500 Quivira Rd
Shawnee Mission, KS 66215
Phone (913) 227-0565

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1215924600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741331",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303741331",
            "telephone_number": "913-469-0503",
            "fax_number": "913-338-1311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11164 S NOBLE DR",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660617572",
            "telephone_number": "913-829-2440",
            "fax_number": "913-338-1311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCH",
        "first_name": "FRED",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-30",
        "last_updated": "2022-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "0528541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "fred.church@cpfc.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "11164 S Noble Dr",
            "city": "Olathe",
            "state": "KS",
            "country_code": "US",
            "postal_code": "660617572",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Olathe, KS

Sources for this page

Verify at the official NPI Registry.