Kimberly Dawn Ponnuru, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

0429857 Issued in KS

Practice address

7450 Kessler St
Ste 201
Merriam, KS 66204

Phone

(913) 632-9200

Fax

(913) 632-9209

NPI assigned

Sep 29, 2006

Last updated

Nov 5, 2019By the provider in NPPES

Sex

Female

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

University of Kansas School of Med (KC/Wich/Sal), 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shawnee Mission Medical Center IncGroup PAC ID 9537119037, 282 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

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

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kponnuru661244@adventhealth.direct-ci.com

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.

• Shawnee Mission Medical Center Inc

  dba AdventHealth Medical Group

  • Family Medicine Physician
  • Merriam, KS
  • NPI 1992735690
  Medicare reassignment Care Compare group NPD
• Providence Care Inc

  • Family Medicine Physician
  • Kansas City, KS
  • NPI 1477860112
  NPD (past)

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

• Shawnee Mission Medical Center Inc

  dba AdventHealth Shawnee Mission

  • 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": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572912000000",
    "number": "1689766230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7450 KESSLER ST",
            "address_2": "STE 201",
            "city": "MERRIAM",
            "state": "KS",
            "postal_code": "66204",
            "telephone_number": "913-632-9200",
            "fax_number": "913-632-9209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7450 KESSLER ST",
            "address_2": "STE 201",
            "city": "MERRIAM",
            "state": "KS",
            "postal_code": "66204",
            "telephone_number": "913-632-9200",
            "fax_number": "913-632-9209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONNURU",
        "first_name": "KIMBERLY",
        "middle_name": "DAWN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-29",
        "last_updated": "2019-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KS",
            "license": "0429857",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KS STATE BOARD OF HEALING",
            "identifier": "0429857",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pinnacle Therapy Services LLC
• Alexia Paige Pisoni
• Jaclyn C Piszczek, MD
• Margaret Pogge
• Abby Pollard, LSCSW
• Nina Popper
• David Vaughn Porter Jr., PA-C
• Possabilities Therapy
• Alissa Ann Potocnik, M.S., CCC-SLP
• Heather Nicole Price, PT, DPT

• Surgery Physician in Merriam, KS
• Providers in Merriam, KS by specialty
• Surgery Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2019; 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.