Icare Primary Care

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

20110330076 Issued in MO

Legal business name

ICARE PRIMARY CARE

Practice address

550 Rush Creek Pkwy
Suite B
Liberty, MO 64068-9608

Phone

(816) 875-4325

Fax

(816) 407-9809

NPI assigned

Dec 2, 2014

Last updated

Dec 2, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Petersen

Title

Office Manager

Phone

(816) 875-4325

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• iCARE Addiction Clinic Other name

Tax ID family

Icare Addiction Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Icare Primary Care Clinic, LLC

  • Substance Abuse Rehabilitation Facility
  • Liberty, MO
  • NPI 1699173757
  NPD tax ID

Locations

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

{
    "created_epoch": "1417478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417478400000",
    "number": "1316344658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 RUSH CREEK PKWY",
            "address_2": "SUITE B",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "640689608",
            "telephone_number": "816-875-4325",
            "fax_number": "816-407-9809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 RUSH CREEK PKWY",
            "address_2": "SUITE B",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "640689608",
            "telephone_number": "816-875-4325",
            "fax_number": "816-407-9809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICARE PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-02",
        "last_updated": "2014-12-02",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "816-875-4325"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MO",
            "license": "20110330076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN",
            "identifier": "1699716910",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "iCARE Addiction Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ryan L Huyser, M.D.
• Hy-Vee Health PC
• Hy-Vee Health PC
• Hy-Vee Inc (Hy-Vee Pharmacy (1384))
• Alex Hyden
• Icare Primary Care Clinic, LLC
• Adil Imam, MD
• Inline Chiropractic Center, LLC
• J.E.a. Wegener Inc (Richards & Wegener, Optometrists)
• Makiya Jackson

• Exclusive Provider Organization in Liberty, MO
• Providers in Liberty, MO by specialty
• Exclusive Provider Organization in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2014; 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.