NPIMap

Organization Active NPI

Renu Medical & Spa, LLC

  • Family Medicine Physician
  • Pittsburg, KS
National Provider Identifier
1881050995
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0438483 Issued in KS
Legal business name
RENU MEDICAL & SPA, LLC
Practice address
2425 Bradshaw Way
Pittsburg, KS 66762-8756
Phone
(620) 308-6123
Fax
(620) 308-6264
NPI assigned
Jan 5, 2016
Last updated
Dec 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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

Authorized official

Name
Jacqueline M Youtsos, MDNPI 1780950352
Title
Owner
Phone
(620) 308-6123

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 0438483 KS Primary

Addresses

Primary practice location

2425 Bradshaw Way
Pittsburg, KS 66762-8756

Mailing address

2425 Bradshaw Way
Pittsburg, KS 66762-8756
Phone (620) 308-6123

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS, NM2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160111001098 KS Part B Supplier - Clinic/Group Practice 9739481573 Receives reassigned benefits from 5 practitioners
Practice locations: Fort Scott, KS; Pittsburg, KS; Parsons, KS; Iola, KS; Girard, KS
O20241120004257 NM Part B Supplier - Clinic/Group Practice 9739481573 Receives reassigned benefits from 3 practitioners
Practice locations: Ruidoso, NM

National Provider Directory

National Provider Directory

Locations

1711 S National Ave
Ste C
Fort Scott, KS 66701

1711 S National Ave
Ste E
Fort Scott, KS 66701
Phone (620) 223-0850

113 S 13TH St
Parsons, KS 67357

113 S 18th St
Parsons, KS 67357

2425 Bradshaw Way
Pittsburg, KS 66762

909 E Centennial Dr
Ste 6
Pittsburg, KS 66762
Phone (620) 231-5940

708 Mechem Dr
Ste B
Ruidoso, NM 88345
Phone (505) 273-0982

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": "1451952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607558400000",
    "number": "1881050995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2425 BRADSHAW WAY",
            "city": "PITTSBURG",
            "state": "KS",
            "postal_code": "667628756",
            "telephone_number": "620-308-6123",
            "fax_number": "620-308-6264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 BRADSHAW WAY",
            "city": "PITTSBURG",
            "state": "KS",
            "postal_code": "667628756",
            "telephone_number": "620-308-6123",
            "fax_number": "620-308-6264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENU MEDICAL & SPA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-05",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A",
        "authorized_official_last_name": "YOUTSOS",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "620-308-6123",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "0438483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pittsburg, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 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.