Cedar Creek Medical Group LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

CEDAR CREEK MEDICAL GROUP LLC

Practice address

100 NW Mock Ave
Blue Springs, MO 64014-2501

Phone

(816) 463-6001

Fax

(816) 463-6004

NPI assigned

May 26, 2006

Organization subpart

No

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

Authorized official

Name

Patrick Kueny

Title

VP

Phone

(816) 463-6001

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219017600000",
    "number": "1699721951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 NW MOCK AVE",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640142500",
            "telephone_number": "816-463-6001",
            "fax_number": "816-463-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NW MOCK AVE",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640142501",
            "telephone_number": "816-463-6001",
            "fax_number": "816-463-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR CREEK MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2008-08-18",
        "status": "A",
        "authorized_official_last_name": "KUENY",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "816-463-6001"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200543790 A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500672704",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamie Lyn Carver, LCSW
• Lacey Hillerman Case, NP
• Michelle Cass, APRN
• Alberto Ramon Castaneda, DDS FAGD
• Baleigh Q Cates
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• Internal Medicine Physician in Blue Springs, MO
• Providers in Blue Springs, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2008; 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.