Spine & Scoliosis Surgery, Inc.

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

License

R5717 Issued in MO

Legal business name

SPINE & SCOLIOSIS SURGERY, INC.

Practice address

2790 Clay Edwards Dr Ste 630
North Kansas City, MO 64116

Phone

(816) 471-6611

Fax

(816) 471-6192

NPI assigned

Jan 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Roger P. Jackson, M.D.

Title

President

Phone

(816) 471-6611

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528156800000",
    "number": "1609923366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2790 CLAY EDWARDS DR STE 630",
            "city": "NORTH KANSAS CITY",
            "state": "MO",
            "postal_code": "641163274",
            "telephone_number": "816-471-6611",
            "fax_number": "816-471-6192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2790 CLAY EDWARDS DR STE 630",
            "city": "NORTH KANSAS CITY",
            "state": "MO",
            "postal_code": "64116",
            "telephone_number": "816-471-6611",
            "fax_number": "816-471-6192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE & SCOLIOSIS SURGERY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2018-06-05",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "816-471-6611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "MO",
            "license": "R5717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4571391",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "200018411",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "09-00221",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KC",
            "identifier": "012289011",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shalini Smith, CRNA
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• Michael E Somers, M.D.
• Sarah Southwell, PA-C
• Abby Rose Spexarth, PA
• Spine Surgery, LTD.
• Rebecca Linnea St John, MA
• Cassandra St. Louis-Herod, BSN, RN
• Karl R Stark, MD
• Steven K Starr, MD

• Orthopaedic Surgery of the Spine Physician in North Kansas City, MO
• Providers in North Kansas City, MO by specialty
• Orthopaedic Surgery of the Spine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2018; 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.