Individual provider Active NPI

Tracy Sudtelgte, LCSW

  • Clinical Social Worker
  • Lees Summit, MO
National Provider Identifier
1689302317
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2025007092 Issued in MO
Practice address
1535 NE Rice Rd
Lees Summit, MO 64086-5849
Phone
(816) 966-0900
Fax
(816) 347-3200
NPI assigned
Aug 10, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2025007092 MO Primary

Addresses

Primary practice location

1535 NE Rice Rd
Lees Summit, MO 64086-5849

Mailing address

1555 NE Rice Rd
Lees Summit, MO 64086-5849
Phone (816) 347-3069

Other identifiers 1

IdentifierTypeStateIssuer
2021016829OtherMOMO LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250407002966 MO Practitioner - Clinical Social Worker 2769906148 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Rediscover CurrentSince Mar 7, 2025 Accepting new patients
Rediscover CurrentSince Mar 7, 2025 Accepting new patients

Locations

1535 NE Rice Rd
Lees Summit, MO 64086
Phone (816) 347-3069

1555 NE Rice Rd
Lees Summit, MO 64086
Phone (816) 347-3069

901 NE Independence Ave
Lees Summit, MO 64086
Phone (816) 246-1800

7001 Blue Ridge Blvd
Raytown, MO 64133
Phone (816) 988-2739

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1660089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1689302317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 NE RICE RD",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640865849",
            "telephone_number": "816-347-3069",
            "fax_number": "816-347-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1535 NE RICE RD",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640865849",
            "telephone_number": "816-966-0900",
            "fax_number": "816-347-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDTELGTE",
        "first_name": "TRACY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-10",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2025007092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MO LICENSE",
            "identifier": "2021016829",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lees Summit, MO

Sources for this page

Verify at the official NPI Registry.