NPIMap

Organization Active NPI

NTTR Medical LLC

Doing business as Nelopher Medical Group

  • Internal Medicine Physician
  • Lenexa, KS
National Provider Identifier
1740641455
Registry record updated Mar 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0431411 Issued in KS
Legal business name
NTTR MEDICAL LLC
Doing business as
Nelopher Medical Group
Practice address
14433 W 86TH Ter
Lenexa, KS 66215-4178
Phone
(913) 634-3540
Fax
(913) 825-6358
NPI assigned
Mar 9, 2016
Last updated
Mar 9, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2016

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

Authorized official

Name
Mr. Waddah Y Ghosheh
Title
Practice Manager
Phone
(913) 634-3540

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0431411 KS Primary

Addresses

Primary practice location

14433 W 86TH Ter
Lenexa, KS 66215-4178

Mailing address

9506 W 149TH Ter
Overland Park, KS 66221-8202
Phone (913) 302-5188

Other identifiers 1

IdentifierTypeStateIssuer
1023159522OtherKSINDIVIDUAL NPI

Other names 1

  • NELOPHER MEDICAL GROUP Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160721001457 KS Part B Supplier - Clinic/Group Practice 2466745906 Receives reassigned benefits from 17 practitioners
Practice locations: Leawood, KS; Lenexa, KS; Overland Park, KS

National Provider Directory

National Provider Directory

Locations

12720 State Line Rd
Leawood, KS 66209
Phone (913) 565-2722

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1457481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457481600000",
    "number": "1740641455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9506 W 149TH TER",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662218202",
            "telephone_number": "913-302-5188",
            "fax_number": "913-825-6358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14433 W 86TH TER",
            "city": "LENEXA",
            "state": "KS",
            "postal_code": "662154178",
            "telephone_number": "913-634-3540",
            "fax_number": "913-825-6358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NTTR MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-09",
        "last_updated": "2016-03-09",
        "status": "A",
        "authorized_official_last_name": "GHOSHEH",
        "authorized_official_first_name": "WADDAH",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "913-634-3540",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "0431411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1023159522",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NELOPHER MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lenexa, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2016; 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.