Sam Allen Detwiler, MD, ATC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

94-11926 Issued in KS

Practice address

3901 Rainbow Blvd # Ms 2027
Kansas City, KS 66160-0006

Phone

(913) 588-3974

NPI assigned

Mar 30, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1490832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1871025767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 RAINBOW BLVD # MS 1046",
            "city": "KANSAS CITY",
            "state": "KS",
            "postal_code": "661608500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 RAINBOW BLVD # MS 2027",
            "city": "KANSAS CITY",
            "state": "KS",
            "postal_code": "661600006",
            "telephone_number": "913-588-3974"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3901 Rainbow Blvd # MS 1046",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "KS",
            "postal_code": "661600006",
            "country_code": "US",
            "telephone_number": "913-588-6777",
            "fax_number": "913-588-6765",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DETWILER",
        "first_name": "SAM",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "MD, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-30",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT8023",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "KS",
            "license": "94-11926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eileen M Derks-Wilson, FNP-BC
• Ronald G. Deskin, D.D.S.
• Thomas Deskin, MD
• Katie Detmer
• Lauren Michelle Detwiler, MD
• Michael Deutschmann
• Aditya Krishna Devarakonda, MD
• Michelle Deves
• Robert P Devine, MD
• Brooklyn Devries, MD

• Physical Medicine & Rehabilitation Physician in Kansas City, KS
• Providers in Kansas City, KS by specialty
• Physical Medicine & Rehabilitation Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.