NPIMap

Individual provider Active NPI

Cory Tyson Carpenter, D.O.

  • Internal Medicine Physician
  • Overland Park, KS
National Provider Identifier
1679833800
Registry record updated Apr 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
05-47099 Issued in KS
Practice address
10787 Nall Ave Ste 310
Overland Park, KS 66211-1301
Phone
(913) 945-6900
Fax
(913) 946-6970
NPI assigned
May 22, 2012
Last updated
Apr 4, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2015014048 MO
Internal Medicine Physician 207R00000X 05-47099 KS Primary

Addresses

Primary practice location

10787 Nall Ave Ste 310
Overland Park, KS 66211-1301

Mailing address

10787 Nall Ave Ste 310
Overland Park, KS 66211-1301
Phone (913) 945-6900

Other identifiers 1

IdentifierTypeStateIssuer
1679833800MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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
I20230404002263 KS Practitioner - Internal Medicine 1759697790 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Kansas School of Med (KC/Wich/Sal), 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jayhawk Primary Care IncGroup PAC ID 8123928900, 157 clinicians
Ability KCGroup PAC ID 0143116368, 166 clinicians

Practice addresses (Care Compare)

10787 Nall Ave
310 Medical Plaza Internal Medicine
Overland Park, KS 66211-1301
Phone (913) 945-6900

3011 Baltimore Ave
Kansas City, MO 64108-3403
Phone (816) 751-7832

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2015014048MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jayhawk Primary Care Inc Internal Medicine CurrentSince Mar 23, 2023 Accepting new patients
Jayhawk Primary Care Inc Internal Medicine Current Accepting new patients
Jayhawk Primary Care Inc Internal Medicine CurrentSince Mar 23, 2023 Accepting new patients
Jayhawk Primary Care Inc Past Accepting new patients

Locations

11300 Corporate Ave
Ste 342
Lenexa, KS 66219
Phone (913) 574-0425

10787 Nall Ave
Ste 310
Overland Park, KS 66211
Phone (913) 945-6800

7405 Renner Rd
Shawnee Msn, KS 66217
Phone (913) 588-2200

Interoperability endpoints

  • Direct secure messaging: ccarpenter72178@direct.kuha.org

Organizations & group practices 5

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 9

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": "1337644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680566400000",
    "number": "1679833800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10787 NALL AVE STE 310",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111301",
            "telephone_number": "913-945-6900",
            "fax_number": "913-945-6970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10787 NALL AVE STE 310",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111301",
            "telephone_number": "913-945-6900",
            "fax_number": "913-946-6970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARPENTER",
        "first_name": "CORY",
        "middle_name": "TYSON",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-22",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2015014048",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "05-47099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679833800",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

Verify at the official NPI Registry.