NPIMap

Individual provider Active NPI

Mark Idstrom, MD

  • Diagnostic Radiology Physician
  • Shawnee Mission, KS
National Provider Identifier
1639264443
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
R2J97 Issued in MO
Practice address
9100 W 74TH St
Shawnee Mission, KS 66204-4004
Phone
(913) 676-2310
NPI assigned
Oct 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X R2J97 MO Primary

Addresses

Primary practice location

9100 W 74TH St
Shawnee Mission, KS 66204-4004

Mailing address

9212 Nieman Rd
Overland Park, KS 66214-1868
Phone (913) 599-6777

Other identifiers 1

IdentifierTypeStateIssuer
15144081OtherBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040624000406 MO Practitioner - Diagnostic Radiology 8224013016 Reassigns benefits to 1 organization
I20160323002342 FL Practitioner - Diagnostic Radiology 8224013016 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Minnesota Medical School, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Hospital Dr
Columbia, MO 65212-0001
Phone (573) 882-4141

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.23 of 100Reported as group
Quality
58.17
Promoting interoperability
100
Improvement activities
40
Cost
75.92

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R2J97MOMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians Inc Diagnostic Radiology CurrentSince Apr 13, 2017 Accepting new patients
Proscan NCH Imaging LLC Diagnostic Radiology CurrentSince Jun 18, 2021 Accepting new patients
Proscan NCH Imaging LLC Diagnostic Radiology CurrentSince Jun 18, 2021 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Apr 13, 2017 Accepting new patients
Sheridan Radiology Services of Pinellas, Inc. Diagnostic Radiology Current Accepting new patients
The Curators of the University of Missouri CurrentSince Aug 16, 2022 Accepting new patients
Curators of the University of Missouri CurrentSince Aug 16, 2022 Accepting new patients
University of Florida Jacksonville Physicians, Inc. Diagnostic Radiology Current Accepting new patients
Brevard Physician Associates, PLLC Diagnostic Radiology CurrentSince Mar 28, 2016 Accepting new patients
Alliance Radiology, PA Diagnostic Radiology Past Accepting new patients
Midwest Radiology Inc Past Accepting new patients
Radiology Associates of Kansas City, LLC Past Accepting new patients
Midwest Radiology, Inc. Diagnostic Radiology Past Accepting new patients
Medical Plaza Imaging Associates, LLC Diagnostic Radiology Past Accepting new patients

Locations

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

1350 Hickory St
Melbourne, FL 32901
Phone (321) 434-1771

1020 Crosspointe Dr
Ste 103
Naples, FL 34110
Phone (239) 624-4443

404 N Keene St
Columbia, MO 65201
Phone (573) 875-9000

1 Hospital Dr
Columbia, MO 65212
Phone (573) 882-2568

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639264443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9212 NIEMAN RD",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662141868",
            "telephone_number": "913-599-6777",
            "fax_number": "913-599-3955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9100 W 74TH ST",
            "city": "SHAWNEE MISSION",
            "state": "KS",
            "postal_code": "662044004",
            "telephone_number": "913-676-2310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDSTROM",
        "first_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "R2J97",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "15144081",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shawnee Mission, KS

Sources for this page

Verify at the official NPI Registry.