Individual provider Active NPI

John M Wubbenhorst Jr., DO

  • Psychiatry Physician
  • Lees Summit, MO
National Provider Identifier
1295744605
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
2004007620 Issued in MO
Practice address
901 NE Independence Ave
Lees Summit, MO 64086-5544
Phone
(816) 246-8000
Fax
(816) 246-8207
NPI assigned
Aug 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 2004007620 MO Primary
Child & Adolescent Psychiatry Physician 2084P0804X 2004007620 MO

Addresses

Primary practice location

901 NE Independence Ave
Lees Summit, MO 64086-5544

Mailing address

28806 SE Moreland School Rd
Blue Springs, MO 64014-6006
Phone (816) 229-4061

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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 1

Enrollment IDStateProvider typePAC IDDetails
I20040518000942 MO Practitioner - Psychiatry 2567453756 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2004007620MOMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rediscover CurrentSince Jan 9, 2013 Accepting new patients
Rediscover CurrentSince Jan 9, 2013 Accepting new patients
Psychpros of Kansas City PastSince Feb 4, 2024 Accepting new patients
Psychiatry Associates of Kansas City PA Psychiatry PastSince Nov 1, 1990 Accepting new patients

Locations

1555 NE Rice Rd
Lees Summit, MO 64086
Phone (816) 347-3069

1515 NE Rice Rd
Lees Summit, MO 64086
Phone (816) 347-3011

901 NE Independence Ave
Lees Summit, MO 64086
Phone (816) 246-1800

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1295744605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28806 SE MORELAND SCHOOL RD",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640146006",
            "telephone_number": "816-229-4061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 NE INDEPENDENCE AVE",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640865544",
            "telephone_number": "816-246-8000",
            "fax_number": "816-246-8207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WUBBENHORST",
        "first_name": "JOHN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "2004007620",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MO",
            "license": "2004007620",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lees Summit, MO

Sources for this page

Verify at the official NPI Registry.