Timothy C Stallard, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

1500547 Issued in KS

Practice address

23401 Prairie Star Pkwy
Suite 300
Lenexa, KS 66227-7268

Phone

(913) 677-6319

Fax

(913) 677-1540

NPI assigned

Apr 7, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1994

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

KC Bariatric LLCGroup PAC ID 3375600182, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventhealth Shawnee Mission Hospital, Shawnee Mission, KS, CCN 170104

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• KC Bariatric, LLC

  • Surgery Physician
  • Lenexa, KS
  • NPI 1992945307
  Medicare reassignment Care Compare group
• Midwest Anesthesia Associates, PA

  • Anesthesiology Physician
  • Shawnee Mission, KS
  • NPI 1336192392
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Shawnee Mission Medical Center Inc

  • General Acute Care Hospital
  • Merriam, KS
  • NPI 1023171634
  Care Compare affiliation
• Shawnee Mission Medical Center Inc

  • Clinical Medical Laboratory
  • Merriam, KS
  • NPI 1235792003

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1679536148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23401 PRAIRIE STAR PKWY STE B300",
            "city": "LENEXA",
            "state": "KS",
            "postal_code": "662277268",
            "telephone_number": "913-677-6319",
            "fax_number": "913-677-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23401 PRAIRIE STAR PKWY",
            "address_2": "SUITE 300",
            "city": "LENEXA",
            "state": "KS",
            "postal_code": "662277268",
            "telephone_number": "913-677-6319",
            "fax_number": "913-677-1540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLARD",
        "first_name": "TIMOTHY",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-07",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "KS",
            "license": "1500547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30004502040004",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brett William Sramek, DO
• St Lukes Pathology Associates PA
• Lisa Jane St. Aubyn, LSCSW
• Stefani Stakley
• Donald Jullian Stallard Jr., MD
• Mary Stanley, M.A. CCC SLP
• Tatiana Staples
• Anna K Starks
• Starlight ABA KS LLC
• Stephen G. Schulte, D.D.S., P.a.

• Surgical Physician Assistant in Lenexa, KS
• Providers in Lenexa, KS by specialty
• Surgical Physician Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.