Summit Skin Care Incorporated

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

102868 Issued in MO

Legal business name

SUMMIT SKIN CARE INCORPORATED

Doing business as

Summit Skin and Vein Care

Practice address

3521 NE Ralph Powell Rd Ste C
Lees Summit, MO 64064-2324

Phone

(816) 554-8346

Fax

(816) 554-9470

NPI assigned

Aug 27, 2007

Organization subpart

No

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

Authorized official

Name

Bruce E Fearon, MDNPI 1689666059

Title

Owner / President

Phone

(816) 554-7546

Specialties & licenses 1

Addresses

Other names 1

• Summit Skin and Vein Care Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 5

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.

• Bruce E Fearon, M.D.

  • Family Medicine Physician
  • Lee's Summit, MO
  • NPI 1689666059
  Medicare reassignment Care Compare group NPD Authorized official
• Makenzie Kayla Stroup, FNP-BC

  • Family Nurse Practitioner
  • Lee's Summit, MO
  • NPI 1063132827
  Medicare reassignment Care Compare group NPD
• Joseph M Baker, D.O.

  • Family Medicine Physician
  • Lee's Summit, MO
  • NPI 1922086693
  Medicare reassignment Care Compare group
• Brianna Frederick, APRN (AGNP-C)

  • Adult Health Nurse Practitioner
  • Lee's Summit, MO
  • NPI 1619837689
  Medicare reassignment Care Compare group
• Paige Motwani, FNP

  • Family Nurse Practitioner
  • Lee's Summit, MO
  • NPI 1336849553
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663286400000",
    "number": "1902099500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3521 NE RALPH POWELL RD STE C",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640642324",
            "telephone_number": "816-554-8346",
            "fax_number": "816-554-9470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3521 NE RALPH POWELL RD STE C",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640642324",
            "telephone_number": "816-554-8346",
            "fax_number": "816-554-9470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT SKIN CARE INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-27",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A",
        "authorized_official_last_name": "FEARON",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER / PRESIDENT",
        "authorized_official_telephone_number": "816-554-7546",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "102868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit Skin and Vein Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Summit Skin and Vein Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Summit Pediatrics, LLC
• Summit Plastic Surgery Inc
• Summit Rehabilitation and Wellness Center, LLC
• Summit Ridge Counseling Group, Inc
• Summit RX, LLC (SummitRx Pharmacy)
• Summit Sleep Solutions LLC
• Summit Strength Physical Therapy, LLC
• Summit Therapy Solutions LLC
• Summit Village Family Dental LLC
• Sundance Rehabilitation Corp

• Family Medicine Physician in Lee's Summit, MO
• Providers in Lee's Summit, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; 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.