Individual provider Active NPI

Immaculate Kume Ngum, FNP

  • Nurse Practitioner
  • Raytown, MO
National Provider Identifier
1578190062
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
80845 Issued in KS
Practice address
8219 E 85TH Ter
Raytown, MO 64138-3020
Phone
(816) 204-1334
NPI assigned
Mar 24, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Registered Nurse 163WG0600X 23541795 MO
Nurse Practitioner 363L00000X 80845 KS Primary

Addresses

Primary practice location

8219 E 85TH Ter
Raytown, MO 64138-3020

Mailing address

8219 E 85TH Ter
Raytown, MO 64138-3020
Phone (816) 204-1334

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS, TX3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20220207000336 MO Practitioner - Nurse Practitioner 4880087311 Reassigns benefits to 3 organizations
Practice locations: Raytown, MO
I20220329000116 KS Practitioner - Nurse Practitioner 4880087311 Reassigns benefits to 4 organizations
I20260507000066 TX Practitioner - Nurse Practitioner 4880087311 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Quill Medical TXGroup PAC ID 3678070208, 5 clinicians

Practice addresses (Care Compare)

4949 Westgrove Dr
Dallas, TX 75248-1923
Phone (833) 870-0904

Merit-based Incentive Payment System (MIPS)

Final score
89.72 of 100Reported as apm
Quality
72.97
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
23541795MOMDGerontology Registered Nurse
80845KSMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Inpatient Consultants of Kansas PA CurrentSince May 6, 2024 Accepting new patients
Minuteclinic Diagnostic of Kansas PA CurrentSince Jan 7, 2022 Accepting new patients
Signify Health, LLC Nurse Practitioner CurrentSince Apr 26, 2022 Accepting new patients
Kansas Post Acute Medical Services 1 PA CurrentSince Feb 1, 2022 Accepting new patients
Inpatient Consultants of Kansas PA CurrentSince May 6, 2024 Accepting new patients
Theoria Medical Nurse Practitioner CurrentSince Oct 19, 2024 Accepting new patients
CS Pacs 3 Midwest LLC CurrentSince Sep 26, 2024 Accepting new patients
NV Pacs 2 LLC CurrentSince Feb 1, 2022 Accepting new patients
Harwood Healthcare Corp PastSince Feb 4, 2024 Accepting new patients

Locations

1643 NW 136th Ave
Ste 100
Sunrise, FL 33323
Phone (865) 500-1325

15040 W 138th St
Olathe, KS 66062
Phone (913) 254-7265

17500 W 119th St
Olathe, KS 66061
Phone (913) 213-1686

1301 S Main St
Ottawa, KS 66067
Phone (785) 229-3367

601 E Main St
Pretty Prairie, KS 67570
Phone (620) 459-6822

9100 W 74th St
Shawnee Msn, KS 66204
Phone (913) 632-2230

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

3825 S Noland Rd
Independence, MO 64055
Phone (816) 254-6002

9191 N Ambassador Dr
Kansas City, MO 64154
Phone (816) 491-6190

2300 Main St
Fl 9
Kansas City, MO 64108
Phone (800) 416-1767

8021 Watson Rd
Webster Groves, MO 63119
Phone (314) 963-0398

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1578190062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8219 E 85TH TER",
            "city": "RAYTOWN",
            "state": "MO",
            "postal_code": "641383020",
            "telephone_number": "816-204-1334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8219 E 85TH TER",
            "city": "RAYTOWN",
            "state": "MO",
            "postal_code": "641383020",
            "telephone_number": "816-204-1334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUM",
        "first_name": "IMMACULATE",
        "middle_name": "KUME",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-24",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "MO",
            "license": "23541795",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KS",
            "license": "80845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raytown, MO

Sources for this page

Verify at the official NPI Registry.