NPIMap

Organization Active NPI

Statland Medical Group LLC

  • Internal Medicine Physician
  • Overland Park, KS
National Provider Identifier
1902123573
Registry record updated Nov 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
STATLAND MEDICAL GROUP LLC
Practice address
5701 W 119TH St
Suite 240
Overland Park, KS 66209-3721
Phone
(913) 345-8500
Fax
(913) 647-3936
NPI assigned
Apr 22, 2010
Last updated
Nov 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2025

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

Authorized official

Name
Benjamin Calkins
Title
Group Vice President
Phone
(615) 372-6536

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X NU

Addresses

Primary practice location

5701 W 119TH St
Suite 240
Overland Park, KS 66209-3721

Mailing address

2000 Health Park Dr
Brentwood, TN 37027-4692
Phone (615) 373-7406

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100914001260 KS Part B Supplier - Clinic/Group Practice 0042335044 Receives reassigned benefits from 5 practitioners
Practice locations: Overland, KS; Overland Park, KS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D0887927Statland Medical Group5701 West 119TH Street, Suite 330, Lab Room #2, Overland Park, KS 66209Certificate of waiverJun 22, 2028

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

7381 W 133rd St
Ste 1
Overland Park, KS 66213

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1271894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763596800000",
    "number": "1902123573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274692",
            "telephone_number": "615-373-7406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5701 W 119TH ST",
            "address_2": "SUITE 240",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662093721",
            "telephone_number": "913-345-8500",
            "fax_number": "913-647-3936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATLAND MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-22",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A",
        "authorized_official_last_name": "CALKINS",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "GROUP VICE PRESIDENT",
        "authorized_official_telephone_number": "615-372-6536"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Nov 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.