NPIMap

Organization Active NPI

College Park Family Care Center, P.a.

  • Radiology Clinic/Center
  • Overland Park, KS
National Provider Identifier
1881803229
Registry record updated Aug 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
COLLEGE PARK FAMILY CARE CENTER, P.A.
Practice address
11755 W 112TH St
Ste. 101
Overland Park, KS 66210-2761
Phone
(913) 469-0503
Fax
(913) 338-1311
NPI assigned
May 22, 2007
Last updated
Aug 10, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2007

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

Authorized official

Name
Chuck Chambers
Title
Administrator
Phone
(913) 469-0503

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X NU Primary

Addresses

Primary practice location

11755 W 112TH St
Ste. 101
Overland Park, KS 66210-2761

Mailing address

11755 W 112TH St
Ste. 101
Overland Park, KS 66210-2761
Phone (913) 469-0503

Other identifiers 2

IdentifierTypeStateIssuer
0484665OtherKSAETNA
5696741OtherKSAETNA

Other names 1

  • College Park Radiology Other name

National Provider Directory

National Provider Directory
Tax ID family
College Park Family Care Center PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 90

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 90

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186704000000",
    "number": "1881803229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11755 W 112TH ST",
            "address_2": "STE. 101",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662102761",
            "telephone_number": "913-469-0503",
            "fax_number": "913-338-1311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11755 W 112TH ST",
            "address_2": "STE. 101",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662102761",
            "telephone_number": "913-469-0503",
            "fax_number": "913-338-1311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEGE PARK FAMILY CARE CENTER, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2007-08-10",
        "status": "A",
        "authorized_official_last_name": "CHAMBERS",
        "authorized_official_first_name": "CHUCK",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "913-469-0503"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0484665",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5696741",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "College Park Radiology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Overland Park, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.