NPIMap

Organization Active NPI

Johnson County Dermatology P.a.

  • Dermatology Physician
  • Olathe, KS
National Provider Identifier
1457642845
Registry record updated Apr 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
JOHNSON COUNTY DERMATOLOGY P.A.
Practice address
153 W 151St St
Suite 100
Olathe, KS 66061-5348
Phone
(913) 764-1125
Fax
(913) 764-1186
NPI assigned
Apr 20, 2011
Last updated
Apr 20, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2011

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

Authorized official

Name
Jan-Marie Kroh, M.D.NPI 1902836125
Title
President
Phone
(913) 764-1125

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
Dermatology Physician 207N00000X Primary

Addresses

Primary practice location

153 W 151St St
Suite 100
Olathe, KS 66061-5348

Mailing address

153 W 151St St
Suite 100
Olathe, KS 66061-5348
Phone (913) 764-1125

Other identifiers 1

IdentifierTypeStateIssuer
DE7997OtherKSRAILROAD MEDICARE

Other names 1

  • John L. Proffitt, M.D., P.A. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051112000012 KS Part B Supplier - Clinic/Group Practice 3870555428 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
Practice locations: Olathe, KS

National Provider Directory

National Provider Directory

Locations

153 W 151st St
Ste 100
Olathe, KS 66061
Phone (913) 764-1125

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": "1303257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303257600000",
    "number": "1457642845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 W 151ST ST",
            "address_2": "SUITE 100",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660615348",
            "telephone_number": "913-764-1125",
            "fax_number": "913-764-1186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 W 151ST ST",
            "address_2": "SUITE 100",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660615348",
            "telephone_number": "913-764-1125",
            "fax_number": "913-764-1186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON COUNTY DERMATOLOGY P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-20",
        "last_updated": "2011-04-20",
        "status": "A",
        "authorized_official_last_name": "KROH",
        "authorized_official_first_name": "JAN-MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "913-764-1125",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DE7997",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "John L. Proffitt, M.D., P.A.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Olathe, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2011; 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.