Active NPI
Midtown Family Medicine PC
- Family Medicine Physician
- Kansas City, MO
National Provider Identifier
1376784835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 36683
- Legal business name
- MIDTOWN FAMILY MEDICINE PC
- Practice address
- 3406 Broadway Blvd Ste B
Kansas City, MO 64111-2767 - Phone
- (816) 756-5839
- Fax
- (816) 756-5874
- NPI assigned
- Mar 13, 2009
- Last updated
- Apr 14, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan Diebold
- Title
- Office Manager
- Phone
- (816) 756-5839
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 36683 | MO | Primary |
Addresses
Primary practice location
3406 Broadway Blvd Ste B
Kansas City, MO 64111-2767
Mailing address
3406 Broadway Blvd Ste B
Kansas City, MO 64111-2767
Phone (816) 756-5839
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D1012019 | Midtown Family Medicine, PC | Provider-performed microscopy | May 12, 2027 |
National Provider Directory
National Provider DirectoryLocations
4620 J C Nichols Pkwy
Ste 405
Kansas City, MO 64112
Phone (816) 960-0300
Practitioners & affiliated clinicians
Practitioners 11
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.
-
- Internal Medicine Physician
- Kansas City, MO
- NPI 1447255005
-
- Adult Health Nurse Practitioner
- Kansas City, MO
- NPI 1982497350
-
- Internal Medicine Physician
- Overland Park, KS
- NPI 1972701571
MO, Multi-Specialty
-
- Physician Assistant
- Kansas City, MO
- NPI 1013725803
-
- Physician Assistant
- Kansas City, MO
- NPI 1356235014
-
- Family Nurse Practitioner
- Kansas City, MO
- NPI 1962778407
-
- Nephrology Physician
- Kansas City, MO
- NPI 1346005337
-
- Pulmonary Disease Physician
- Overland Park, KS
- NPI 1295825685
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236902400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1618358400000",
"number": "1376784835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3406 BROADWAY BLVD STE B",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641112767",
"telephone_number": "816-756-5839",
"fax_number": "816-756-5874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3406 BROADWAY BLVD STE B",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641112767",
"telephone_number": "816-756-5839",
"fax_number": "816-756-5874"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MIDTOWN FAMILY MEDICINE PC",
"organizational_subpart": "NO",
"enumeration_date": "2009-03-13",
"last_updated": "2021-04-14",
"certification_date": "2020-12-14",
"status": "A",
"authorized_official_last_name": "DIEBOLD",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "816-756-5839"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "MO",
"license": "36683",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Kansas City, MO
- Mary Jo Middleton, M.D.
- Michelle Renee Middleton, AU.D.
- Roseanne Marie Middleton, PH.D.
- Midland Health Care, LLC
- Midtown Dental LLC (Comfort Dental Midtown)
- Midtown Health Center, LLC
- Midtown Muscle and Joint LLC
- Midtown Orthodontics, LLC
- Midtown Pediatric Dentistry (The Smile Spot)
- Midtown Psychological Services, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.