NPIMap

Organization Active NPI

Dynamos Anesthesia Services LLC

  • Anesthesiology Physician
  • Leavenworth, KS
National Provider Identifier
1639719180
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
DYNAMOS ANESTHESIA SERVICES LLC
Practice address
3550 S 4TH St
Leavenworth, KS 66048-5071
Phone
(913) 680-6000
NPI assigned
Jan 13, 2020
Last updated
Nov 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Authorized official

Name
Kelly Gordon, CRNANPI 1063495711
Title
Owner
Phone
(913) 522-0889

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207L00000X Primary
Certified Registered Nurse AnesthetistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 367500000X

Addresses

Primary practice location

3550 S 4TH St
Leavenworth, KS 66048-5071

Mailing address

29800 W 127TH St
Olathe, KS 66061-8636
Phone (913) 522-0889

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200224000829 KS Part B Supplier - Clinic/Group Practice 1052748589 Receives reassigned benefits from 43 practitioners
Practice locations: Leavenworth, KS
O20210914000296 MO Part B Supplier - Clinic/Group Practice 1052748589 Receives reassigned benefits from 51 practitioners
Practice locations: Kansas City, MO; Warrensburg, MO; Saint Joseph, MO

National Provider Directory

National Provider Directory

Locations

1318 E 104th St
#C
Kansas City, MO 64131
Phone (816) 256-5200

901 Heartland Rd
Ste 1820
Saint Joseph, MO 64506
Phone (816) 232-8877

Practitioners & affiliated clinicians

Practitioners 85

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 85

NPI Registry JSON

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

{
    "created_epoch": "1578873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1639719180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29800 W 127TH ST",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660618636",
            "telephone_number": "913-522-0889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 S 4TH ST",
            "city": "LEAVENWORTH",
            "state": "KS",
            "postal_code": "660485071",
            "telephone_number": "913-680-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMOS ANESTHESIA SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-13",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "913-522-0889",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leavenworth, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.