NPIMap

Organization Active NPI

Jackson County Gastroenterology PC

  • Gastroenterology Physician
  • Blue Springs, MO
National Provider Identifier
1386699718
Registry record updated Dec 31, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
JACKSON COUNTY GASTROENTEROLOGY PC
Practice address
206 NW Mock Ave
Suite 100
Blue Springs, MO 64014-2507
Phone
(816) 229-1191
Fax
(816) 229-1198
NPI assigned
May 24, 2006
Last updated
Dec 31, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2009

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

Authorized official

Name
Dr. Gregory M Vardakis, DONPI 1841296274
Title
Owner
Phone
(816) 229-1191

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

206 NW Mock Ave
Suite 100
Blue Springs, MO 64014-2507

Mailing address

PO Box 412622
Kansas City, MO 64141-2622
Phone (816) 229-1191

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040903000071 MO Part B Supplier - Clinic/Group Practice 7012983877 Receives reassigned benefits from 10 practitioners
Practice locations: Appleton City, MO; Blue Springs, MO; Independence, MO

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262217600000",
    "number": "1386699718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 412622",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641412622",
            "telephone_number": "816-229-1191",
            "fax_number": "816-229-1198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 NW MOCK AVE",
            "address_2": "SUITE 100",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640142507",
            "telephone_number": "816-229-1191",
            "fax_number": "816-229-1198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON COUNTY GASTROENTEROLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2009-12-31",
        "status": "A",
        "authorized_official_last_name": "VARDAKIS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "816-229-1191",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blue Springs, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.