NPIMap

Individual provider Active NPI

David D Edalati, MD

  • Internal Medicine Physician
  • Overland Park, KS
National Provider Identifier
1477669141
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0424423 Issued in KS
Practice address
7011 W 121St St Ste 106
Overland Park, KS 66209-2009
Phone
(913) 884-1055
Fax
(913) 884-1066
NPI assigned
Aug 22, 2006
Last updated
Aug 23, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0424423 KS Primary

Addresses

Primary practice location

7011 W 121St St Ste 106
Overland Park, KS 66209-2009

Mailing address

7011 W 121St St Ste 106
Overland Park, KS 66209-2009
Phone (913) 884-1055

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101008000618 KS Practitioner - Internal Medicine 8527014976 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Kansas School of Med (KC/Wich/Sal), 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

7011 W 121St St
Suite 106
Overland Park, KS 66209-2009
Phone (913) 884-1055

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue22
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0424423KSMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Medical Consultant LLC Internal Medicine CurrentSince Jul 14, 2014 Accepting new patients
Ignite Medical Resort Overland Park LLC Past Accepting new patients
Carondelet Long Term Care Facilities Inc Past Accepting new patients

Locations

11901 Rosewood St
Overland Park, KS 66209
Phone (913) 345-1745

7011 W 121st St
Ste 106
Overland Park, KS 66209
Phone (913) 884-1055

10500 Quivira Rd
Shawnee Mission, KS 66215
Phone (913) 227-0565

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1477669141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7011 W 121ST ST STE 106",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662092009",
            "telephone_number": "913-884-1055",
            "fax_number": "913-884-1066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7011 W 121ST ST STE 106",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662092009",
            "telephone_number": "913-884-1055",
            "fax_number": "913-884-1066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDALATI",
        "first_name": "DAVID",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "0424423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

Verify at the official NPI Registry.