NPIMap

Individual provider Active NPI

Russell David Fike, PA-C

  • Physician Assistant
  • Olathe, KS
National Provider Identifier
1891252680
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
15-02556 Issued in KS
Practice address
18200 W 119TH St
Olathe, KS 66061-9507
Phone
(913) 355-8350
NPI assigned
Feb 27, 2019
Last updated
Nov 29, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 56568 CA
Physician Assistant 363A00000X 15-02556 KS Primary
Medical Physician Assistant 363AM0700X 56568 CA

Addresses

Primary practice location

18200 W 119TH St
Olathe, KS 66061-9507

Mailing address

18200 W 119TH St
Olathe, KS 66061-9507
Phone (913) 355-8350

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211203001796 KS Practitioner - Physician Assistant 8224367479 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jayhawk Primary Care IncGroup PAC ID 8123928900, 157 clinicians

Practice addresses (Care Compare)

15435 W 134TH PL
Suite 103
Olathe, KS 66062-6135
Phone (913) 588-1227

7405 Renner Rd
Shawnee, KS 66217-9414
Phone (913) 588-8400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
56568CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Olathe Health Physicians, Inc. CurrentSince Dec 31, 2021 Accepting new patients
Jayhawk Primary Care Inc CurrentSince Jan 1, 2024 Accepting new patients
Olathe Health Physicians, Inc. CurrentSince Dec 31, 2021 Accepting new patients
Jayhawk Primary Care Inc CurrentSince Jan 1, 2024 Accepting new patients
Jayhawk Primary Care Inc Past Accepting new patients

Locations

11300 Corporate Ave
Ste 342
Lenexa, KS 66219
Phone (913) 574-0425

18200 W 119th St
Olathe, KS 66061
Phone (913) 355-8350

20805 W 151st St
Ste 400
Olathe, KS 66061
Phone (913) 355-4900

23450 College Blvd
Olathe, KS 66061
Phone (913) 355-7788

7405 Renner Rd
Shawnee Msn, KS 66217
Phone (913) 588-2200

Interoperability endpoints

  • Direct secure messaging: rfike755578@direct.kuha.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1551225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1891252680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18200 W 119TH ST",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660619507",
            "telephone_number": "913-355-8350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18200 W 119TH ST",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660619507",
            "telephone_number": "913-355-8350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIKE",
        "first_name": "RUSSELL",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-02-27",
        "last_updated": "2021-11-29",
        "certification_date": "2021-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "56568",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-02556",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "56568",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olathe, KS

Sources for this page

Verify at the official NPI Registry.