NPIMap

Organization Active NPI

Kansas City Internal Medicine PA

  • Internal Medicine Physician
  • Overland Park, KS
National Provider Identifier
1316969884
Registry record updated Oct 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
111706 Issued in MO
Legal business name
KANSAS CITY INTERNAL MEDICINE PA
Practice address
12140 Nall Ave
Suite 100
Overland Park, KS 66209-2504
Phone
(913) 451-8500
Fax
(913) 451-1754
NPI assigned
Jul 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2014

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

Authorized official

Name
Jean A Hansen, MBA, FACMPE
Title
Ceo
Phone
(913) 319-7303

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 111706 MO Primary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X 103093 MO

Addresses

Primary practice location

12140 Nall Ave
Suite 100
Overland Park, KS 66209-2504

Mailing address

12140 Nall Ave
Suite 100
Overland Park, KS 66209-2504
Phone (913) 451-8500

Other identifiers 2

IdentifierTypeStateIssuer
200305470MedicaidKS
506936400MedicaidMO

National Provider Directory

National Provider Directory

Locations

12140 Nall Ave
Ste 100
Overland Park, KS 66209
Phone (913) 451-8500

6700 W 121st St
Ste 103
Overland Park, KS 66209
Phone (913) 451-7777

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414022400000",
    "number": "1316969884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12140 NALL AVE",
            "address_2": "SUITE 100",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662092504",
            "telephone_number": "913-451-8500",
            "fax_number": "913-451-1754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12140 NALL AVE",
            "address_2": "SUITE 100",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662092504",
            "telephone_number": "913-451-8500",
            "fax_number": "913-451-1754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANSAS CITY INTERNAL MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-24",
        "last_updated": "2014-10-23",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "913-319-7303",
        "authorized_official_credential": "MBA, FACMPE"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "111706",
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MO",
            "license": "103093",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200305470",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "506936400",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.