Individual provider Active NPI

Jackson Alan Mores, PT, DPT, MPH

  • Physical Therapist
  • Overland Park, KS
National Provider Identifier
1477224293
Registry record updated Aug 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11006773 Issued in KS
Practice address
10730 Nall Ave Ste 200
Overland Park, KS 66211-1285
Phone
(913) 588-1227
NPI assigned
Sep 22, 2021
Last updated
Aug 29, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2021032083 MO
Physical Therapist 225100000X 11006773 KS Primary

Addresses

Primary practice location

10730 Nall Ave Ste 200
Overland Park, KS 66211-1285

Mailing address

10730 Nall Ave Ste 200
Overland Park, KS 66211-1285
Phone (913) 588-1227

Other practice location 1

8302 W 125th St
Overland Park, KS 66213-1400
Phone (913) 239-0646

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211105002597 KS Practitioner - Physical Therapist in Private Practice 5496144875 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11006773KSMDPhysical Therapist
2021032083MOMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Kansas University Physicians Inc Current Accepting new patients
Kansas University Physicians Inc CurrentSince Oct 12, 2021 Accepting new patients
Kansas University Physicians Inc CurrentSince Oct 12, 2021 Accepting new patients

Locations

3901 Rainbow Blvd
Kansas City, KS 66160
Phone (913) 588-6005

11300 Corporate Ave
Ste 342
Lenexa, KS 66219
Phone (913) 574-0425

10730 Nall Ave
Ste 200
Overland Park, KS 66211
Phone (913) 574-1460

8302 W 125th St
Overland Park, KS 66213
Phone (913) 239-0646

Organizations & group practices 3

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": "1632268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693267200000",
    "number": "1477224293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10730 NALL AVE STE 200",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111285",
            "telephone_number": "913-588-1227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10730 NALL AVE STE 200",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111285",
            "telephone_number": "913-588-1227"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8302 W 125th St",
            "address_purpose": "LOCATION",
            "city": "Overland Park",
            "state": "KS",
            "postal_code": "662131400",
            "country_code": "US",
            "telephone_number": "913-239-0646",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORES",
        "first_name": "JACKSON",
        "middle_name": "ALAN",
        "credential": "PT, DPT, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-22",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2021032083",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11006773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; 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.