Krishna Manej Divadeenam, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

04-28281 Issued in KS

Practice address

200 NE Missouri Rd
Suite 302
Lees Summit, MO 64086-4722

Phone

(816) 523-0103

Fax

(816) 361-6471

NPI assigned

Aug 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

Psychiatry

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

MCCD KS Psychiatry Services PAGroup PAC ID 4385094598, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• MCCD KS Psychiatry Services PA

  • Psychiatry Physician
  • Overland Park, KS
  • NPI 1487422234

  KS, Psychiatry

  Medicare reassignment Care Compare group NPD
• Kansas City University

  • Dental Clinic/Center
  • Joplin, MO
  • NPI 1295773638
  NPD (past)
• Midwest Psychiatric Consultants, P.C.

  • Specialist
  • Lees Summit, MO
  • NPI 1265472088
  NPD (past)

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314835200000",
    "number": "1376652149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NE MISSOURI RD",
            "address_2": "SUITE 302",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640864722",
            "telephone_number": "816-523-0103",
            "fax_number": "816-361-6471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 NE MISSOURI RD",
            "address_2": "SUITE 302",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640864722",
            "telephone_number": "816-523-0103",
            "fax_number": "816-361-6471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVADEENAM",
        "first_name": "KRISHNA",
        "middle_name": "MANEJ",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2011-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "KS",
            "license": "04-28281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100098010",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KC",
            "identifier": "30445011",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Marie Anna Dierking, D.C.
• Kylie B Digiacinto, CRNA
• John Dimaggio, D.C., M.S.
• Carl E Dippel, LCMFT
• Dissociative Associates, LLC
• Diversity Placement Services, Inc.
• Andrea Louise Dixon, MA, LPC
• April S Dixon, LPC
• Misty Dawn Dixon, LCSW
• Laura Brown Doan, M.D.

• Psychiatry Physician in Lees Summit, MO
• Providers in Lees Summit, MO by specialty
• Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.