NPIMap

Organization Active NPI

Rejuvenate Inc

  • Clinical Psychologist
  • Lees Summit, MO
National Provider Identifier
1669617841
Registry record updated Jan 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
REJUVENATE INC
Practice address
400 SW Longview Blvd Ste 160
Lees Summit, MO 64081-2112
Phone
(816) 761-3944
Fax
(866) 335-7993
NPI assigned
Dec 2, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2012

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

Authorized official

Name
Scott J Symes, PSY DNPI 1063496487
Title
Owner
Phone
(816) 812-6820

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

400 SW Longview Blvd Ste 160
Lees Summit, MO 64081-2112

Mailing address

400 SW Longview Blvd Ste 160
Lees Summit, MO 64081-2112
Phone (816) 761-3944

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090217000673 MO Part B Supplier - Clinic/Group Practice 0244395762 Receives reassigned benefits from 5 practitioners
Practice locations: Lees Summit, MO

National Provider Directory

National Provider Directory

Locations

3367 NE Ralph Powell Rd
Lees Summit, MO 64064
Phone (816) 246-0111

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1228176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326240000000",
    "number": "1669617841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 SW LONGVIEW BLVD STE 160",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640812112",
            "telephone_number": "816-761-3944",
            "fax_number": "866-335-7993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 SW LONGVIEW BLVD STE 160",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640812112",
            "telephone_number": "816-761-3944",
            "fax_number": "866-335-7993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REJUVENATE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-02",
        "last_updated": "2012-01-11",
        "status": "A",
        "authorized_official_last_name": "SYMES",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "816-812-6820",
        "authorized_official_credential": "PSY D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lees Summit, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; 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.