Individual provider Active NPI

Jessica Cullen, PA-C

  • Surgical Physician Assistant
  • Lee's Summit, MO
National Provider Identifier
1467733345
Registry record updated Jan 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Practice address
2861 NE Independence Ave Ste 201
Lees Summit, MO 64064-2379
Phone
(816) 525-2840
Fax
(816) 525-2841
NPI assigned
Sep 6, 2011
Last updated
Jan 7, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MO
Surgical Physician Assistant 363AS0400X MO Primary

Addresses

Primary practice location

2861 NE Independence Ave Ste 201
Lees Summit, MO 64064-2379

Mailing address

2861 NE Independence Ave Ste 201
Lees Summit, MO 64064-2379
Phone (816) 525-2840

Other practice location 1

12330 Metcalf Ave Ste 400
Overland Park, KS 66213-1307
Phone (816) 525-2840

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20111005000436 MO Practitioner - Physician Assistant 7416129911 Reassigns benefits to 2 organizations
I20210112000067 KS Practitioner - Physician Assistant 7416129911 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Orthopedics and Sports MedicineGroup PAC ID 8820370422, 45 clinicians

Practice addresses (Care Compare)

121 N Dean Ave
Suite 101
Raymore, MO 64083-8398
Phone (816) 525-2840

2861 NE Independence Ave
Suite 201
Lees Summit, MO 64064-2379
Phone (816) 525-2840

505 S Hospital Dr
Paola, KS 66071-1850
Phone (816) 525-2840

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Orthopedics and Sports Medicine CurrentSince Oct 19, 2020 Accepting new patients

Locations

11340 Nall Ave
Ste 200
Overland Park, KS 66211
Phone (913) 354-5020

12330 Metcalf Ave
Ste 400
Overland Park, KS 66213
Phone (913) 317-7990

505 S Hospital Dr
Paola, KS 66071
Phone (913) 232-9846

2861 NE Independence Ave
Ste 201
Lees Summit, MO 64064
Phone (660) 281-8118

121 N Dean Ave
Ste 101
Raymore, MO 64083

Organizations & group practices 2

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1315267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1467733345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2861 NE INDEPENDENCE AVE STE 201",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640642379",
            "telephone_number": "816-525-2840",
            "fax_number": "816-525-2841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2861 NE INDEPENDENCE AVE STE 201",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640642379",
            "telephone_number": "816-525-2840",
            "fax_number": "816-525-2841"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12330 Metcalf Ave Ste 400",
            "address_purpose": "LOCATION",
            "city": "Overland Park",
            "state": "KS",
            "postal_code": "662131307",
            "country_code": "US",
            "telephone_number": "816-525-2840",
            "fax_number": "816-525-2841",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CULLEN",
        "first_name": "JESSICA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-06",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lee's Summit, MO

Sources for this page

Verify at the official NPI Registry.