Individual provider Active NPI

Jordan Andrew Dykstra, MD

  • Dermatology Physician
  • Overland Park, KS
National Provider Identifier
1336775402
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
04-51181 Issued in KS
Practice address
10740 Nall Ave
Overland Park, KS 66211-1367
Phone
(913) 588-1227
NPI assigned
Mar 20, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 04-51181 KS Primary

Addresses

Primary practice location

10740 Nall Ave
Overland Park, KS 66211-1367

Mailing address

11201 Outlook St Apt 1217
Overland Park, KS 66211-1958

Other practice location 1

1400 W 22nd St
Sioux Falls, SD 57105-1554
Phone (605) 357-1380

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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
I20250823000380 KS Practitioner - Dermatology 8729482880 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kansas University Physicians IncGroup PAC ID 8921911587, 1,809 clinicians

Practice addresses (Care Compare)

10740 Nall Ave
Overland Park, KS 66211-1367
Phone (913) 588-1227

Hospital & facility affiliations

  • University of Kansas Hospital Hospital, Kansas City, KS, CCN 170040

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision12
Removal of skin lesions222
Skin biopsy109

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0601SDMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Kansas University Physicians Inc CurrentSince Aug 18, 2025 Accepting new patients
Kansas University Physicians Inc Current Accepting new patients
Kansas University Physicians Inc CurrentSince Aug 18, 2025 Accepting new patients

Locations

3901 Rainbow Blvd
Kansas City, KS 66160
Phone (913) 588-6005

4000 Cambridge St
Kansas City, KS 66160
Phone (913) 588-0000

2000 Olathe
Kansas City, KS 66160
Phone (913) 588-1908

11300 Corporate Ave
Lenexa, KS 66219
Phone (913) 574-0600

10740 Nall Ave
Overland Park, KS 66211

Interoperability endpoints

  • Direct secure messaging: jdykstra696818@direct.kuha.org

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1584662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1336775402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11201 OUTLOOK ST APT 1217",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10740 NALL AVE",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111367",
            "telephone_number": "913-588-1227"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 W 22nd St",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571051554",
            "country_code": "US",
            "telephone_number": "605-357-1380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DYKSTRA",
        "first_name": "JORDAN",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-20",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "KS",
            "license": "04-51181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

Verify at the official NPI Registry.