Signature Medical Group of KC, P.a.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

SIGNATURE MEDICAL GROUP OF KC, P.A.

Practice address

12639 Old Tesson Rd
Suite 115
Saint Louis, MO 63128-2786

Phone

(314) 849-0311

Fax

(314) 849-4423

NPI assigned

Nov 29, 2011

Last updated

Aug 27, 2024By 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

Mr. Mike Stephenson

Title

Administator

Phone

(913) 381-5225

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Signature Medical Group of KC, PA

  • Durable Medical Equipment & Medical Supplies
  • Lee's Summit, MO
  • NPI 1194116061

  7618144056

  Same PAC ID
• Signature Medical Group of KC, P.a.

  • Orthopaedic Surgery Physician
  • Overland Park, KS
  • NPI 1992087266

  7618144056

  Same PAC ID

Tax ID family

Signature Medical GRP KC PA5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Signature Medical Group of KC, PA

  • Durable Medical Equipment & Medical Supplies
  • Lee's Summit, MO
  • NPI 1194116061
  NPD tax ID
• Signature Medical Group of KC PA

  • Physician Assistant
  • Overland Park, KS
  • NPI 1093265142
  NPD tax ID
• Signature Medical Group of KC PA

  • Surgical Physician Assistant
  • Overland Park, KS
  • NPI 1447708755
  NPD tax ID
• Signature Medical Group of KC, PA

  • Durable Medical Equipment & Medical Supplies
  • Shawnee Mission, KS
  • NPI 1952797755
  NPD tax ID

Locations

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

{
    "created_epoch": "1322524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724716800000",
    "number": "1467729988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10701 NALL AVE",
            "address_2": "SUITE 200",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111363",
            "telephone_number": "913-381-5225",
            "fax_number": "913-901-0186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12639 OLD TESSON RD",
            "address_2": "SUITE 115",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282786",
            "telephone_number": "314-849-0311",
            "fax_number": "314-849-4423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIGNATURE MEDICAL GROUP OF KC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-29",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A",
        "authorized_official_last_name": "STEPHENSON",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "ADMINISTATOR",
        "authorized_official_telephone_number": "913-381-5225",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "6684440001",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Signature Healthcare Foundaiton (Signature Foundation Rehabilitation)
• Signature Healthcare Foundation (Signature Foundation Rehabilitation)
• Signature Healthcare Foundation (Signature Foundation Rehabilitaiton)
• Signature Healthcare Foundation (Signature Foundation Rehabilitation)
• Signature Home Health Care LLC
• Signature Medical Group, Inc
• Signature Medical Group, Inc
• Signature Medical Group, Inc.
• Rosette Marie Signorelli, L.C.S.W.
• Wendy Catherine Sigurdson

• Durable Medical Equipment & Medical Supplies in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Durable Medical Equipment & Medical Supplies in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; 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.