Active NPI
Jennifer Teegarden, MD
- Family Medicine Physician
- Overland Park, KS
National Provider Identifier
1720054315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 04-31254
- Practice address
- 12330 Metcalf Ave
Suite 400
Overland Park, KS 66213-1324 - Phone
- (913) 317-7990
- Fax
- (913) 317-7018
- NPI assigned
- Feb 24, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 04-31254 | KS | Primary |
Addresses
Primary practice location
12330 Metcalf Ave
Suite 400
Overland Park, KS 66213-1324
Mailing address
12330 Metcalf Ave
Suite 400
Overland Park, KS 66213-1324
Phone (913) 317-7990
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200366620B | Medicaid | KS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 1, 2020 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-31254 | KS | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301356800000",
"number": "1720054315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12330 METCALF AVE",
"address_2": "SUITE 400",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662131324",
"telephone_number": "913-317-7990",
"fax_number": "913-317-7018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12330 METCALF AVE",
"address_2": "SUITE 400",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662131324",
"telephone_number": "913-317-7990",
"fax_number": "913-317-7018"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEEGARDEN",
"first_name": "JENNIFER",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-24",
"last_updated": "2011-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "KS",
"license": "04-31254",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200366620B",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Overland Park, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2011; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.