Active NPI
Mark Andrew Connelly, PHD
- Clinical Child & Adolescent Psychologist
- Kansas City, MO
National Provider Identifier
1407874753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 2006016149
- Practice address
- 2401 Gillham Rd
Kansas City, MO 64108-4619 - Phone
- (816) 234-3000
- Fax
- (816) 302-9939
- NPI assigned
- Jul 17, 2006
- Last updated
- Dec 22, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | LP1679 | KS | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 2006016149 | MO | Primary |
Addresses
Primary practice location
2401 Gillham Rd
Kansas City, MO 64108-4619
Mailing address
2401 Gillham Rd
Attn Provider Enrollment Dept
Kansas City, MO 64108-4619
Phone (816) 701-5200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO, KS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- University of Kansas School of Med (KC/Wich/Sal), 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2401 Gillham Rd
Kansas City, MO 64108-4619
Phone (816) 234-3000
5520 College Blvd
Overland Park, KS 66211-1630
Phone (913) 696-8000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP1679 | KS | MD | Clinical Child & Adolescent Psychologist |
| 1679 | KS | MD | Hearing Instrument Specialist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1766361600000",
"number": "1407874753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2401 GILLHAM RD",
"address_2": "ATTN PROVIDER ENROLLMENT DEPT",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641084619",
"telephone_number": "816-701-5200",
"fax_number": "816-302-9939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 GILLHAM RD",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641084619",
"telephone_number": "816-234-3000",
"fax_number": "816-302-9939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNELLY",
"first_name": "MARK",
"middle_name": "ANDREW",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2025-12-22",
"certification_date": "2025-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "KS",
"license": "LP1679",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MO",
"license": "2006016149",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Kansas City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2025; 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.