Kelly S Tieves, DO

Primary specialty

Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X

License

2006034491 Issued in MO

Practice address

2401 Gillham Rd
Children'S Mercy Hospital
Kansas City, MO 64108-4619

Phone

(816) 234-3041

NPI assigned

May 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Banner Physician Super Specialists Arizona LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1841573870
  Medicare reassignment NPD
• Banner Physician Super Specialists Arizona LLC

  • Durable Medical Equipment & Medical Supplies
  • Mesa, AZ
  • NPI 1386462810
  NPD
• Banner Physician Super Specialists Arizona LLC

  • Nutrition Education Nutritionist
  • Glendale, AZ
  • NPI 1578125738
  NPD
• Banner Desert Medical Center

  • General Acute Care Hospital
  • Mesa, AZ
  • NPI 1720011810
  NPD (past)

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425427200000",
    "number": "1598716243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 GILLHAM RD",
            "address_2": "CHILDREN'S MERCY HOSPITAL",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641084619",
            "telephone_number": "816-234-3041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 GILLHAM RD",
            "address_2": "CHILDREN'S MERCY HOSPITAL",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641084619",
            "telephone_number": "816-234-3041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIEVES",
        "first_name": "KELLY",
        "middle_name": "S",
        "name_prefix": "Ms.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-15",
        "last_updated": "2015-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "MO",
            "license": "2006034491",
            "primary": true
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "KS",
            "license": "05-32228",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32542500",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "004000215J",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kerri Ann Tidwell, MSN, RN
• Victoria Danelle Tidwell
• James Tiehen, M.D.
• Jennifer Tieman, M.D.
• Vicki Lyn Tietsort, LPN
• Tiffany Springs Rehabilitation & Health Care Center LLC
• Tiffany Springs Senior Care Community
• Tiffany'S Adult Day Care Center LLC
• Allee Jeanne Tiitinen, M.D.
• Jeremiah Tilawen, LCSW

• Pediatric Critical Care Medicine Physician in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Pediatric Critical Care Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.