NPIMap

Organization Active NPI

Jayhawk Primary Care Inc

Doing business as State Avenue Therapy

  • Physical Therapist
  • Kansas City, KS
National Provider Identifier
1740313634
Registry record updated May 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
JAYHAWK PRIMARY CARE INC
Doing business as
State Avenue Therapy
Practice address
4810 State Ave
State Avenue Therapy
Kansas City, KS 66102-1748
Phone
(913) 321-4567
Fax
(913) 321-6789
NPI assigned
Mar 13, 2007
Last updated
May 14, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
JAYHAWK PRIMARY CARE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 14, 2020

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

Authorized official

Name
Angela Mauch
Title
Director of Physician Revenue
Phone
(913) 588-6711

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary
Occupational Therapist 225X00000X

Addresses

Primary practice location

4810 State Ave
State Avenue Therapy
Kansas City, KS 66102-1748

Mailing address

2330 Shawnee Mission Pkwy
Medical Administrative Services of Ku Med, Ste.312
Westwood, KS 66205-2005
Phone (913) 588-9000

Other names 1

  • STATE AVENUE THERAPY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050721001078 KS Part B Supplier - Clinic/Group Practice 8123928900 Receives reassigned benefits from 208 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Overland Park, KS; Westwood, KS; Shawnee, KS; Prairie Village, KS; Olathe, KS; Gardner, KS

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Kupi - Jayhawk

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589414400000",
    "number": "1740313634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 SHAWNEE MISSION PKWY",
            "address_2": "MEDICAL ADMINISTRATIVE SERVICES OF KU MED, STE.312",
            "city": "WESTWOOD",
            "state": "KS",
            "postal_code": "662052005",
            "telephone_number": "913-588-9000",
            "fax_number": "913-588-9822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4810 STATE AVE",
            "address_2": "STATE AVENUE THERAPY",
            "city": "KANSAS CITY",
            "state": "KS",
            "postal_code": "661021748",
            "telephone_number": "913-321-4567",
            "fax_number": "913-321-6789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAYHAWK PRIMARY CARE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JAYHAWK PRIMARY CARE INC",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-05-14",
        "certification_date": "2020-05-14",
        "status": "A",
        "authorized_official_last_name": "MAUCH",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "DIRECTOR OF  PHYSICIAN REVENUE",
        "authorized_official_telephone_number": "913-588-6711"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STATE AVENUE THERAPY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "STATE AVENUE THERAPY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kansas City, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.