Tom Kettler, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0421569 Issued in KS

Practice address

15101 Glenwood Ave
Stanley, KS 66223-3154

Phone

(913) 681-8866

Fax

(913) 338-1311

NPI assigned

Sep 30, 2005

Last updated

Feb 1, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO, KS2 enrollments

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 2

Specialty

Family Practice

Education

University of Kansas School of Med (KC/Wich/Sal), 1985

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)

Hospital & facility affiliations

• Overland Park Reg Med Ctr Hospital, Overland Park, KS, CCN 170176
• University of Kansas Hospital Hospital, Kansas City, KS, CCN 170040
• Saint Luke's South Hospital Hospital, Overland Park, KS, CCN 170185

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tom.kettler@cpfc.eclinicaldirectplus.com
• Direct secure messaging: tom.kettler@hca2.eclinicaldirectplus.com

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.

• Overland Park Surgical Specialties LLC

  dba College Park Family Care Center Physicians Group

  • Family Medicine Physician
  • Overland Park, KS
  • NPI 1760798540
  Medicare reassignment Care Compare group NPD
• Hope Family Care Center,LLC

  • Federally Qualified Health Center (FQHC)
  • Kansas City, MO
  • NPI 1285878793
  Medicare reassignment
• College Park Family Care Center PA

  • Family Medicine Physician
  • Overland Park, KS
  • NPI 1740248772
  NPD
• College Park Family Care Center, P.a.

  • Radiology Clinic/Center
  • Overland Park, KS
  • NPI 1881803229
  NPD (past)
• The Covenant Group PA

  • Emergency Medicine Physician
  • Kansas City, KS
  • NPI 1306814389
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Midwest Division-Oprmc LLC

  dba Overland Park Regional Medical Center

  • General Acute Care Hospital
  • Overland Park, KS
  • NPI 1578500484
  Care Compare affiliation
• Saint Lukes South Hospital, Inc.

  • General Acute Care Hospital
  • Overland Park, KS
  • NPI 1154303337
  Care Compare affiliation
• University of Kansas Hospital Authority

  dba University of Kansas Hospital / University of Kansas Cancer Center

  • General Acute Care Hospital
  • Kansas City, KS
  • NPI 1629369681
  Care Compare affiliation
• University of Kansas Hospital Authority

  dba The University of Kansas Hospital

  • General Acute Care Hospital
  • Kansas City, KS
  • NPI 1649259656
  Care Compare affiliation

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1285621615",
    "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": "913-469-5267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15101 GLENWOOD AVE",
            "city": "STANLEY",
            "state": "KS",
            "postal_code": "662233154",
            "telephone_number": "913-681-8866",
            "fax_number": "913-338-1311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTLER",
        "first_name": "TOM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-30",
        "last_updated": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "0421569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tom.kettler@cpfc.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "15101 Glenwood Ave",
            "city": "Stanley",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662233154",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kylie Hays, PA
• Madeline Howell, FNP/ENP
• Amy J Kapple, R.D. L.D. C.D.E.
• Yutaka Kawase, M.D.
• Anne H Kettler, M.D.
• Brooke Nicole McGuire, NP
• Annalee Neds, FNP-C
• Overland Park Surgical Specialties, LLC (College Park Family Care Center Physicians Group)
• Robert L Schuchardt, M.D.
• Suzanne H Shaffer, M.D.

• Family Medicine Physician in Stanley, KS
• Providers in Stanley, KS by specialty
• Family Medicine Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.