NPIMap

Individual provider Active NPI

Douglas W Kiburz, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Sedalia, MO
National Provider Identifier
1487623260
Registry record updated Mar 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
R5F84 Issued in MO
Practice address
2301 S Ingram Ave
Sedalia, MO 65301-8121
Phone
(660) 826-5890
NPI assigned
Mar 15, 2006
Last updated
Mar 15, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X R5F84 MO Primary

Addresses

Primary practice location

2301 S Ingram Ave
Sedalia, MO 65301-8121

Mailing address

PO Box 843966
Kansas City, MO 64184-3966
Phone (660) 826-5890

Other identifiers 1

IdentifierTypeStateIssuer
509999207MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20100511000185 MO Practitioner - Orthopedic SurgeryPractitioner - Sports Medicine 8022165570 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bothwell Regional Health CenterGroup PAC ID 6103714126, 109 clinicians

Practice addresses (Care Compare)

3700 W 10TH St
Sedalia, MO 65301-2540

601 E 14TH St
Sedalia, MO 65301-5972

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement13
Knee replacement54
Lower limb (leg) arthroscopy (minimally invasive joint repair)15
Upper limb (arm) arthroscopy (minimally invasive joint repair)15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R5F84MOMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bothwell Regional Health Center Current Accepting new patients
Bothwell Regional Health Center CurrentSince Oct 1, 2018 Accepting new patients
Bothwell Regional Health Center CurrentSince Oct 1, 2018 Accepting new patients

Locations

2301 S Ingram Ave
Sedalia, MO 65301
Phone (660) 826-5890

601 E 14th St
Sedalia, MO 65301
Phone (660) 826-8833

Organizations & group practices 5

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 5

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": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458000000000",
    "number": "1487623260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 843966",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641843966",
            "telephone_number": "660-826-5890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 S INGRAM AVE",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653018121",
            "telephone_number": "660-826-5890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIBURZ",
        "first_name": "DOUGLAS",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-15",
        "last_updated": "2016-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "MO",
            "license": "R5F84",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "509999207",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sedalia, MO

Sources for this page

Verify at the official NPI Registry.