Active NPI
Lorraine Theresa Davis, MS, PA-C
- Physician Assistant
- Leawood, KS
National Provider Identifier
1710020367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 15-02452
- Practice address
- 3651 College Blvd
Leawood, KS 66211-1910 - Phone
- (913) 218-0807
- NPI assigned
- Feb 14, 2007
- Last updated
- Feb 16, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PT796 | WY | |
| Physician Assistant | 363A00000X | 15-02452 | KS | Primary |
| Medical Physician Assistant | 363AM0700X | PT796 | WY | |
| Surgical Physician Assistant | 363AS0400X | PT796 | WY |
Addresses
Primary practice location
3651 College Blvd
Leawood, KS 66211-1910
Mailing address
551 W Layton St
Olathe, KS 66061-6396
Phone (714) 944-7720
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710020367 | Medicaid | KS | |
| 1710020367 | Medicaid | CA |
Other names 1
- Lorraine Theresa Clement
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: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230815000930 | KS | Order and Referring Only - Physician Assistant | 1052608031 |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Select Physical Therapy Holdings Inc
Practice addresses (Care Compare)
100 E Kansas St
Lansing, KS 66043-1610
Phone (913) 758-0283
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53628 | CA | MD | Marriage & Family Therapist |
| 15-02452 | KS | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Big Horn Medical Imaging Center, LLC | Past | Accepting new patients |
Interoperability endpoints
- lorraine.davis.p32@direct.medcor.nextgenshare.com
Organizations & group practices 1
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.
-
- Radiology Clinic/Center
- Sheridan, WY
- NPI 1972320596
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Leawood, KS
- NPI 1457364408
-
dba Saint Luke's Hospital of Kansas City
- General Acute Care Hospital
- Kansas City, MO
- NPI 1063494177
-
dba Crittenton Children's Center
- General Acute Care Hospital
- Kansas City, MO
- NPI 1932642972
-
dba Saint Luke's Hospital Infusion Center at Liberty
- General Acute Care Hospital
- Liberty, MO
- NPI 1275926198
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644969600000",
"number": "1710020367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "551 W LAYTON ST",
"city": "OLATHE",
"state": "KS",
"postal_code": "660616396",
"telephone_number": "714-944-7720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3651 COLLEGE BLVD",
"city": "LEAWOOD",
"state": "KS",
"postal_code": "662111910",
"telephone_number": "913-218-0807"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "LORRAINE",
"middle_name": "THERESA",
"name_prefix": "Mrs.",
"credential": "MS, PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-14",
"last_updated": "2022-02-16",
"certification_date": "2022-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WY",
"license": "PT796",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "KS",
"license": "15-02452",
"primary": true
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "WY",
"license": "PT796",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "WY",
"license": "PT796",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1710020367",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1710020367",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LORRAINE",
"last_name": "CLEMENT",
"middle_name": "THERESA",
"credential": "MS, PA-C, ATC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Leawood, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; 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.