Individual provider Active NPI

Albert Lane, DO

  • Family Medicine Physician
  • Saint Joseph, MO
National Provider Identifier
1619939774
Registry record updated Nov 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
RIF70 Issued in MO
Practice address
1115 N. Belt Highway
St. Joseph, MO 64506-2410
Phone
(816) 271-7077
Fax
(816) 271-0421
NPI assigned
Apr 4, 2006
Last updated
Nov 16, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X RIF70 MO Primary

Addresses

Primary practice location

1115 N. Belt Highway
St. Joseph, MO 64506-2410

Mailing address

1115 N. Belt Highway
St. Joseph, MO 64506-2410
Phone (816) 271-7077

Other identifiers 2

IdentifierTypeStateIssuer
1619939774MedicaidMO
200743250AMedicaidKS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
RIF70MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carespot Professional Services LLC CurrentSince Aug 4, 2015 Accepting new patients
Golden Valley Emergency Physicians, LLC Past Accepting new patients

Locations

3500 W 95th St
Leawood, KS 66206
Phone (913) 305-3167

9507 Antioch Rd
Overland Park, KS 66212
Phone (913) 227-4631

1215 NE Coronado Dr
Blue Springs, MO 64014
Phone (816) 622-3342

13551 Madison Ave
Kansas City, MO 64145
Phone (816) 256-3095

Interoperability endpoints

  • Direct secure messaging: albert.lane@direct.mymlc.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353024000000",
    "number": "1619939774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 N. BELT HIGHWAY",
            "city": "ST. JOSEPH",
            "state": "MO",
            "postal_code": "645062410",
            "telephone_number": "816-271-7077",
            "fax_number": "816-271-0421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 N. BELT HIGHWAY",
            "city": "ST. JOSEPH",
            "state": "MO",
            "postal_code": "645062410",
            "telephone_number": "816-271-7077",
            "fax_number": "816-271-0421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANE",
        "first_name": "ALBERT",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-04",
        "last_updated": "2012-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "RIF70",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619939774",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200743250A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2012; 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.