Active NPI
Carondelet Physician Services, Inc.
- Family Medicine Physician
- Blue Springs, MO
National Provider Identifier
1508157991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2000151554
- Legal business name
- CARONDELET PHYSICIAN SERVICES, INC.
- Practice address
- 801 NW Saint Mary Dr
Suite 101
Blue Springs, MO 64014-2524 - Phone
- (816) 988-9998
- Fax
- (816) 988-9997
- NPI assigned
- Apr 20, 2011
- Organization subpart
- Yes
- Parent organization
- CARONDELET HEALTH
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Steven R Cleary
- Title
- VP/Cfo
- Phone
- (816) 943-2819
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2000151554 | MO | Primary |
Addresses
Primary practice location
801 NW Saint Mary Dr
Suite 101
Blue Springs, MO 64014-2524
Mailing address
801 NW Saint Mary Dr
Suite 230
Blue Springs, MO 64014-2524
Phone (816) 655-5792
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39532013 | Other | BCBS OF KANSAS CITY | |
| 501269500 | Medicaid | MO |
Other names 1
- Advanced Family Care
National Provider Directory
National Provider Directory- Part of
- Carondelet Health
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- General Acute Care Hospital
- Kansas City, MO
- NPI 1164401477
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303257600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1303257600000",
"number": "1508157991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 NW SAINT MARY DR",
"address_2": "SUITE 230",
"city": "BLUE SPRINGS",
"state": "MO",
"postal_code": "640142524",
"telephone_number": "816-655-5792",
"fax_number": "816-655-5787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 NW SAINT MARY DR",
"address_2": "SUITE 101",
"city": "BLUE SPRINGS",
"state": "MO",
"postal_code": "640142524",
"telephone_number": "816-988-9998",
"fax_number": "816-988-9997"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CARONDELET PHYSICIAN SERVICES, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "CARONDELET HEALTH",
"enumeration_date": "2011-04-20",
"last_updated": "2011-04-20",
"status": "A",
"authorized_official_last_name": "CLEARY",
"authorized_official_first_name": "STEVEN",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "VP/CFO",
"authorized_official_telephone_number": "816-943-2819",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "MO",
"license": "2000151554",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF KANSAS CITY",
"identifier": "39532013",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "501269500",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Advanced Family Care",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Blue Springs, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.