Individual provider Active NPI

David Jensen, D.O.

  • Emergency Medicine Physician
  • Lee's Summit, MO
National Provider Identifier
1720066624
Registry record updated Nov 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
115495 Issued in MO
Practice address
530 NW Murray Rd
Emergency Department
Lees Summit, MO 64081-1434
Phone
(816) 969-6310
NPI assigned
Jan 3, 2006
Last updated
Nov 6, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 115495 MO Primary

Addresses

Primary practice location

530 NW Murray Rd
Emergency Department
Lees Summit, MO 64081-1434

Mailing address

PO Box 47164
Attn: Lisa Brower
Wichita, KS 67201-7164

Other identifiers 1

IdentifierTypeStateIssuer
243848702MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20070809000671 MO Practitioner - Emergency Medicine 1759281660 Reassigns benefits to 3 organizations
I20130905000151 KS Practitioner - Emergency Medicine 1759281660 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
115495MOMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Missouri Emergency Medicine LLC Emergency Medicine CurrentSince Aug 1, 2025 Accepting new patients
MBS Advantage Inc CurrentSince Dec 31, 2023 Accepting new patients
Patheous Medical PLLC CurrentSince Dec 18, 2023 Accepting new patients
Electric City Emergency Physicians, LLC Emergency Medicine CurrentSince Apr 1, 2022 Accepting new patients
Community Emergency Services Emergency Medicine Past Accepting new patients
East Meyer Blvd Emergency Physicians LLC Emergency Medicine Past Accepting new patients

Locations

10551 Barkley St
Ste 400
Overland Park, KS 66212

7939 Floyd St
Ste 100
Overland Park, KS 66204

615 W Nursery St
Butler, MO 64730
Phone (660) 200-2004

2800 E Rock Haven Rd
Harrisonville, MO 64701
Phone (816) 380-3474

11618 Gravois Rd
Saint Louis, MO 63126
Phone (314) 239-9740

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257465600000",
    "number": "1720066624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 47164",
            "address_2": "ATTN: LISA BROWER",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672017164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NW MURRAY RD",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640811434",
            "telephone_number": "816-969-6310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "DAVID",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-03",
        "last_updated": "2009-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "115495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "243848702",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lee's Summit, MO

Sources for this page

Verify at the official NPI Registry.