Jerry L Old, M.D.

Primary specialty

Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081H0002X

License

04-16260 Issued in KS

Practice address

15329 W 95TH St
Lenexa, KS 66219-1262

Phone

(913) 599-1125

Fax

(913) 599-3554

NPI assigned

Sep 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1158624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1285731752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15329 W 95TH ST",
            "city": "LENEXA",
            "state": "KS",
            "postal_code": "662191262",
            "telephone_number": "913-599-1125",
            "fax_number": "913-599-3554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15329 W 95TH ST",
            "city": "LENEXA",
            "state": "KS",
            "postal_code": "662191262",
            "telephone_number": "913-599-1125",
            "fax_number": "913-599-3554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLD",
        "first_name": "JERRY",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-19",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081H0002X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Hospice and Palliative Medicine",
            "state": "KS",
            "license": "04-16260",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-16260",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTGUARD",
            "identifier": "614032",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS KANSAS CITY",
            "identifier": "32423014",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Lenexa, KS
• Providers in Lenexa, KS by specialty
• Physical Medicine & Rehabilitation Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.