Sue Ann Douglas, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

M7958 Issued in TX

Practice address

2001 Shawnee Mission Pkwy Ste 130
Mission Woods, KS 66205-2060

Phone

(913) 228-2000

Fax

(855) 354-0963

NPI assigned

Jun 14, 2005

Last updated

Apr 1, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Pediatric Dermatology of Kansas City

  • Pediatric Dermatology Physician
  • Mission Woods, KS
  • NPI 1396211678
  NPD Authorized official
• Epiphany Dermatology of Kansas, LLC

  • Dermatology Physician
  • Overland Park, KS
  • NPI 1710444500
  NPD (past)
• Village Chiropractic and Wellness P.L.L.C.

  dba Cornerstone Chiropractic

  • Chiropractor
  • League City, TX
  • NPI 1972750719
  NPD (past)

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585699200000",
    "number": "1497750731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 SHAWNEE MISSION PKWY STE 130",
            "city": "MISSION WOODS",
            "state": "KS",
            "postal_code": "662052060",
            "telephone_number": "913-228-2000",
            "fax_number": "855-354-0963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 SHAWNEE MISSION PKWY STE 130",
            "city": "MISSION WOODS",
            "state": "KS",
            "postal_code": "662052060",
            "telephone_number": "913-228-2000",
            "fax_number": "855-354-0963"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 Augusta Dr",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770572209",
            "country_code": "US",
            "telephone_number": "713-442-2400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "SUE",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-14",
        "last_updated": "2020-04-01",
        "certification_date": "2020-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "M7958",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "194491002",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pediatric Dermatology of Kansas City
• Talkad S Raghuveer, MD

• Dermatology Physician in Mission Woods, KS
• Providers in Mission Woods, KS by specialty
• Dermatology Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.