NPIMap

Individual provider Active NPI

Kathleen M Eubanks-Meng, D.O.

  • Family Medicine Physician
  • Lee's Summit, MO
National Provider Identifier
1669439097
Registry record updated Aug 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2001014618 Issued in MO
Practice address
3601 NE Ralph Powell Rd
Ste C
Lees Summit, MO 64064-2358
Phone
(816) 285-5053
Fax
(816) 842-1974
NPI assigned
Apr 28, 2006
Last updated
Aug 16, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2022

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 2001014618 MO Primary

Addresses

Primary practice location

3601 NE Ralph Powell Rd
Ste C
Lees Summit, MO 64064-2358

Mailing address

5501 NW 62ND Ter Ste 100
Kansas City, MO 64151-2412
Phone (816) 842-4440

Other identifiers 1

IdentifierTypeStateIssuer
207288101MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050222000262 MO Practitioner - Family Practice 2567415300 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clay Platte Family Medicine ClinicGroup PAC ID 3173424231, 24 clinicians

Practice addresses (Care Compare)

5501 NW 62ND Ter
Suite 100
Kansas City, MO 64151-2412
Phone (816) 842-4440

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions12
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2001014618MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clay Platte Family Medicine Clinic Family Medicine CurrentSince Mar 1, 2005 Accepting new patients
Clay Platte Family Medicine Clinic Family Medicine CurrentSince Mar 1, 2005 Accepting new patients
Primary Care Plus, LLC Family Medicine Past Accepting new patients

Locations

5501 NW 62nd Ter
Ste 100
Kansas City, MO 64151
Phone (816) 842-4440

3200 NE Ralph Powell Rd
Lees Summit, MO 64064
Phone (816) 523-4525

3601 NE Ralph Powell Rd
Ste C
Lees Summit, MO 64064
Phone (816) 285-5053

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/032e9fee-d494-4ca3-97ce-b40c8d2eecf6/

Organizations & group practices 3

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.

Hospital & facility affiliations 6

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": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1669439097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5501 NW 62ND TER STE 100",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641512412",
            "telephone_number": "816-842-4440",
            "fax_number": "816-842-1974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 NE RALPH POWELL RD",
            "address_2": "STE C",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640642358",
            "telephone_number": "816-285-5053",
            "fax_number": "816-842-1974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EUBANKS-MENG",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-28",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2001014618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207288101",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lee's Summit, MO

Sources for this page

Verify at the official NPI Registry.