KC Diabetes & Endocrinology PA

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

Legal business name

KC DIABETES & ENDOCRINOLOGY PA

Practice address

11661 College Blvd Ste 100
Overland Park, KS 66210-4107

Phone

(913) 954-8500

Fax

(913) 432-8402

NPI assigned

Aug 15, 2019

Organization subpart

No

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

Authorized official

Name

Mustafa Hussein

Title

Practice Manager

Phone

(913) 954-8500

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

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Angela Marie Pettus, DNP

  • Nurse Practitioner
  • Lenexa, KS
  • NPI 1336873371
  Medicare reassignment Care Compare group NPD
• M Yaser Mounla, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Overland Park, KS
  • NPI 1154399921
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1565827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565827200000",
    "number": "1457907370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11661 COLLEGE BLVD STE 100",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662104107",
            "telephone_number": "913-954-8500",
            "fax_number": "913-432-8402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11661 COLLEGE BLVD STE 100",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662104107",
            "telephone_number": "913-954-8500",
            "fax_number": "913-432-8402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KC DIABETES & ENDOCRINOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-15",
        "last_updated": "2019-08-15",
        "status": "A",
        "authorized_official_last_name": "HUSSEIN",
        "authorized_official_first_name": "MUSTAFA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "913-954-8500"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• KC Connect Physical Therapy LLC
• KC Core Ca LLC
• KC Counseling Center
• KC Dental Professionals, PA
• KC Developmental Therapies, LLC
• KC Hospitalists, P.a.
• KC Mind & Wellness Center LLC
• KC Pathology PA
• KC Rehabilitation Hospital Inc
• KC Smile, P.a.

• Endocrinology, Diabetes & Metabolism Physician in Overland Park, KS
• Providers in Overland Park, KS by specialty
• Endocrinology, Diabetes & Metabolism Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; 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.