NPIMap

Individual provider Active NPI

Kelly Andra, M.D.

  • Internal Medicine Physician
  • Overland Park, KS
National Provider Identifier
1275754202
Registry record updated Feb 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0438218 Issued in KS
Practice address
10787 Nall Ave
Suite 310
Overland Park, KS 66211-1375
Phone
(913) 945-6900
Fax
(913) 945-6970
NPI assigned
May 1, 2007
Last updated
Feb 3, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2007015074 MO
Internal Medicine Physician 207R00000X 0438218 KS Primary

Addresses

Primary practice location

10787 Nall Ave
Suite 310
Overland Park, KS 66211-1375

Mailing address

10787 Nall Ave
Suite 310
Overland Park, KS 66211-1375
Phone (913) 945-6900

Other identifiers 1

IdentifierTypeStateIssuer
205481609MedicaidMO

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
I20150724010589 KS Practitioner - Internal Medicine 8820180995 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Kansas School of Med (KC/Wich/Sal), 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jayhawk Primary Care IncGroup PAC ID 8123928900, 157 clinicians

Practice addresses (Care Compare)

10787 Nall Ave
310 Medical Plaza Internal Medicine
Overland Park, KS 66211-1301
Phone (913) 945-6900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0438218KSMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jayhawk Primary Care Inc Internal Medicine CurrentSince Jul 31, 2015 Accepting new patients
Jayhawk Primary Care Inc Internal Medicine Current Accepting new patients
Jayhawk Primary Care Inc Internal Medicine CurrentSince Jul 31, 2015 Accepting new patients
Jayhawk Primary Care Inc Past Accepting new patients

Locations

10787 Nall Ave
Ste 310
Overland Park, KS 66211
Phone (913) 945-6800

7405 Renner Rd
Shawnee Msn, KS 66217
Phone (913) 588-2200

Interoperability endpoints

  • Direct secure messaging: kandra534274@direct.kuha.org

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 10

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": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486080000000",
    "number": "1275754202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10787 NALL AVE",
            "address_2": "SUITE 310",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111375",
            "telephone_number": "913-945-6900",
            "fax_number": "913-945-6970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10787 NALL AVE",
            "address_2": "SUITE 310",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111375",
            "telephone_number": "913-945-6900",
            "fax_number": "913-945-6970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDRA",
        "first_name": "KELLY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2017-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2007015074",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "0438218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205481609",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

Verify at the official NPI Registry.