NPIMap

Organization Active NPI

Joseph B. Petelin, M.D., Chartered

  • Surgery Physician
  • Shawnee Mission, KS
National Provider Identifier
1649379447
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
417417 Issued in KS
Legal business name
JOSEPH B. PETELIN, M.D., CHARTERED
Practice address
9119 W 74TH St
Suite 255
Shawnee Mission, KS 66204-2236
Phone
(913) 432-5420
Fax
(913) 432-7749
NPI assigned
Sep 21, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Joseph B. Petelin, M.D.NPI 1982658639
Title
Owner of the Practice
Phone
(913) 432-5420

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 417417 KS Primary

Addresses

Primary practice location

9119 W 74TH St
Suite 255
Shawnee Mission, KS 66204-2236

Mailing address

9119 W 74TH St
Suite 255
Shawnee Mission, KS 66204-2236
Phone (913) 432-5420

National Provider Directory

National Provider Directory

Locations

9119 W 74th St
Ste 255
Shawnee Msn, KS 66204
Phone (913) 432-5420

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649379447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9119 W 74TH ST",
            "address_2": "SUITE 255",
            "city": "SHAWNEE MISSION",
            "state": "KS",
            "postal_code": "662042236",
            "telephone_number": "913-432-5420",
            "fax_number": "913-432-7749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9119 W 74TH ST",
            "address_2": "SUITE 255",
            "city": "SHAWNEE MISSION",
            "state": "KS",
            "postal_code": "662042236",
            "telephone_number": "913-432-5420",
            "fax_number": "913-432-7749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSEPH B. PETELIN, M.D., CHARTERED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETELIN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER OF THE PRACTICE",
        "authorized_official_telephone_number": "913-432-5420",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KS",
            "license": "417417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shawnee Mission, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.