Individual provider Active NPI

Thaer Daifallah, DDS

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Kansas City, MO
National Provider Identifier
1699901868
Registry record updated Nov 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
2009013156 Issued in MO
Practice address
2101 Charlotte St
Kansas City, MO 64108-2727
Phone
(816) 404-0500
NPI assigned
Jun 2, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 2009013156 MO
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 60883 KS
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician 2082S0099X 2009013156 MO
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 2009013156 MO Primary

Addresses

Primary practice location

2101 Charlotte St
Kansas City, MO 64108-2727

Mailing address

2301 Holmes St
Kansas City, MO 64108-2640
Phone (816) 404-0500

Other practice location 1

2301 Holmes St
Kansas City, MO 64108-2640
Phone (816) 404-0500

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090715000029 MO Practitioner - Maxillofacial SurgeryPractitioner - Oral Surgery 3072665595 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Maxillofacial SurgeryAlso: Oral Surgery
Education
University of Missouri, Kansas City, School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Health PhysiciansGroup PAC ID 1153235825, 344 clinicians

Practice addresses (Care Compare)

2301 Holmes St
Kansas City, MO 64108-2640
Phone (816) 404-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.53 of 100Reported as group
Quality
59.66
Promoting interoperability
100
Improvement activities
40
Cost
74.66

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
60883KSMDOral & Maxillofacial Surgery (D.M.D.)
2009013156MOMDOral & Maxillofacial Surgery (D.M.D.)

Practice roles

OrganizationSpecialtyStatusNew patients
University Health Physicians Oral & Maxillofacial Surgery CurrentSince Jul 1, 2014 Accepting new patients
Truman Medical Center, Incorporated Past Accepting new patients

Locations

2101 Charlotte St
Ste 350
Kansas City, MO 64108
Phone (816) 404-0550

2101 Charlotte St
Kansas City, MO 64108
Phone (816) 404-0072

2301 Holmes St
Kansas City, MO 64108

2401 Gillham Rd
Kansas City, MO 64108
Phone (816) 234-3380

2310 Holmes St
Ste 800
Kansas City, MO 64108
Phone (816) 218-2500

4407 E 50th Ter
Kansas City, MO 64130
Phone (816) 924-1201

4401 Wornall Rd
Kansas City, MO 64111
Phone (816) 932-2107

7900 Lees Summit Rd
Kansas City, MO 64139
Phone (816) 373-4485

Interoperability endpoints

  • Direct secure messaging: thaer.daifallah@direct.tmcmed.org

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.

Hospital & facility affiliations 1

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": "1243900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605744000000",
    "number": "1699901868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 HOLMES ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641082640",
            "telephone_number": "816-404-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 CHARLOTTE ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641082727",
            "telephone_number": "816-404-0500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2301 Holmes St",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641082640",
            "country_code": "US",
            "telephone_number": "816-404-0500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAIFALLAH",
        "first_name": "THAER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-02",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MO",
            "license": "2009013156",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "KS",
            "license": "60883",
            "primary": false
        },
        {
            "code": "2082S0099X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": "MO",
            "license": "2009013156",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MO",
            "license": "2009013156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.