Active NPI
Bertram Caruthers Jr., M.D.
- Dermatology Physician
- Kansas City, MO
National Provider Identifier
1629074406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- R5307
- Practice address
- 1734 E 63Rd St
Ste 470
Kansas City, MO 64110-5341 - Phone
- (816) 333-6555
- Fax
- (816) 333-6564
- NPI assigned
- Jun 25, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | R5307 | MO | Primary |
Addresses
Primary practice location
1734 E 63Rd St
Ste 470
Kansas City, MO 64110-5341
Mailing address
4048 N 110TH St
Kansas City, KS 66109-4488
Phone (913) 721-1001
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R5307 | MO | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191542400000",
"number": "1629074406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4048 N 110TH ST",
"city": "KANSAS CITY",
"state": "KS",
"postal_code": "661094488",
"telephone_number": "913-721-1001",
"fax_number": "913-721-1012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1734 E 63RD ST",
"address_2": "STE 470",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641105341",
"telephone_number": "816-333-6555",
"fax_number": "816-333-6564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARUTHERS",
"first_name": "BERTRAM",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-25",
"last_updated": "2007-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MO",
"license": "R5307",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kansas City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.