NPIMap

Organization Active NPI

State Line Medical Group LLC

  • Internal Medicine Physician
  • Kansas City, MO
National Provider Identifier
1679529853
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
STATE LINE MEDICAL GROUP LLC
Practice address
7611 State Line Rd
Suite 103
Kansas City, MO 64114-6801
Phone
(816) 333-9886
NPI assigned
May 26, 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
Ken Washington
Title
VP
Phone
(816) 333-9886

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

7611 State Line Rd
Suite 103
Kansas City, MO 64114-6801

Mailing address

7611 State Line Rd
Suite 103
Kansas City, MO 64114-6801
Phone (816) 333-9886

Other identifiers 1

IdentifierTypeStateIssuer
29398029OtherMOBCBS OF KC

National Provider Directory

National Provider Directory

Locations

7611 State Line Rd
Ste 103
Kansas City, MO 64114
Phone (816) 333-9886

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679529853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7611 STATE LINE RD",
            "address_2": "SUITE 103",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641146801",
            "telephone_number": "816-333-9886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7611 STATE LINE RD",
            "address_2": "SUITE 103",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641146801",
            "telephone_number": "816-333-9886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE LINE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WASHINGTON",
        "authorized_official_first_name": "KEN",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "816-333-9886"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KC",
            "identifier": "29398029",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

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.