Radiance Family Care LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

RADIANCE FAMILY CARE LLC

Practice address

1262 W Amity St
Louisburg, KS 66053-7815

Phone

(913) 747-5374

NPI assigned

Oct 22, 2020

Last updated

Oct 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kelli Elizabeth Docman, APRNNPI 1558922583

Title

Aprn

Phone

(913) 747-5374

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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.

• Kelli Elizabeth Docman, APRN

  • Family Nurse Practitioner
  • Louisburg, KS
  • NPI 1558922583
  Medicare reassignment NPD Authorized official
• Theodore J Felts, MD

  • Family Medicine Physician
  • Overland Park, KS
  • NPI 1861436347
  NPD (past)
• Kalie Leinenbach, DNP, FNP-C

  • Family Nurse Practitioner
  • Independence, MO
  • NPI 1518571512
  NPD (past)

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

{
    "created_epoch": "1603324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603324800000",
    "number": "1396344115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16143 FOSTER ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "660858417",
            "telephone_number": "913-747-5374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1262 W AMITY ST",
            "city": "LOUISBURG",
            "state": "KS",
            "postal_code": "660537815",
            "telephone_number": "913-747-5374"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16139 Foster St",
            "address_purpose": "LOCATION",
            "city": "Overland Park",
            "state": "KS",
            "postal_code": "660858417",
            "country_code": "US",
            "telephone_number": "913-747-5374",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RADIANCE FAMILY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-22",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A",
        "authorized_official_last_name": "DOCMAN",
        "authorized_official_first_name": "KELLI",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "APRN",
        "authorized_official_telephone_number": "913-747-5374",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jacob E Polzin, D.C.
• Charles Wesley Powell, M.D.
• Recover-Care Louisburg LLC
• Crystal Raye Renaud, APRN
• Renewed Life Chiropractic, LLC
• Michelle Ridley, LMSW
• Carli Riemer

• Primary Care Clinic/Center in Louisburg, KS
• Providers in Louisburg, KS by specialty
• Primary Care Clinic/Center in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; 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.

Verify at the official NPI Registry.