Individual provider Active NPI

Kayla Gertsema, M.D.

  • Child & Adolescent Psychiatry Physician
  • Kansas City, MO
National Provider Identifier
1700176757
Registry record updated Mar 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
2020004931 Issued in MO
Practice address
10918 Elm Ave Ste 102
Kansas City, MO 64134-2284
Phone
(816) 765-6600
Fax
(816) 767-4107
NPI assigned
Apr 11, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X BP1-0039546 TX
Child & Adolescent Psychiatry Physician 2084P0804X 2020004931 MO Primary

Addresses

Primary practice location

10918 Elm Ave Ste 102
Kansas City, MO 64134-2284

Mailing address

3501 Mills Ave
Austin, TX 78731-6309

Other practice location 1

3501 Mills Ave
Austin, TX 78731-6309
Phone (512) 324-3380

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20171213001320 KS Practitioner - Psychiatry 9537467097 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
BP1-0039546TXMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cottonwood Springs Physician Group LLC Psychiatry CurrentSince Nov 3, 2022 Accepting new patients
Cottonwood Springs Physician Group LLC Past Accepting new patients

Locations

15040 W 138th St
Olathe, KS 66062
Phone (913) 254-7265

13351 S Arapaho Dr
Olathe, KS 66062
Phone (913) 353-3000

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": "1302480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585094400000",
    "number": "1700176757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 MILLS AVE",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787316309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10918 ELM AVE STE 102",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641342284",
            "telephone_number": "816-765-6600",
            "fax_number": "816-767-4107"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3501 Mills Ave",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787316309",
            "country_code": "US",
            "telephone_number": "512-324-3380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GERTSEMA",
        "first_name": "KAYLA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-11",
        "last_updated": "2020-03-25",
        "certification_date": "2020-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "BP1-0039546",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MO",
            "license": "2020004931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.