Mary Beth Duryea, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

R9N37 Issued in MO

Practice address

4130 NE Hampstead Dr
Lees Summit, MO 64064-1619

Phone

(816) 373-7136

NPI assigned

Jul 25, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• State Line Medical Group LLC

  • Internal Medicine Physician
  • Kansas City, MO
  • NPI 1679529853
  NPD (past)

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

{
    "created_epoch": "1374710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374710400000",
    "number": "1912349374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4130 NE HAMPSTEAD DR",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640641619",
            "telephone_number": "816-373-7136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4130 NE HAMPSTEAD DR",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640641619",
            "telephone_number": "816-373-7136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURYEA",
        "first_name": "MARY",
        "middle_name": "BETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-07-25",
        "last_updated": "2013-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175F00000X",
            "taxonomy_group": "",
            "desc": "Naturopath",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R9N37",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dava Alyxandra Dull
• Edward Franklin Dullenty, RN BSNMA
• Jerod Duncan
• Rian B Dunkin, LPC, MA
• Jamie Durner, NBC-HWC
• Ciara Dawn Dutton, OTR/L
• Dynamic Spine & Joint Center
• Robin Leslie Dyson, M.D.
• Nicholas Patrick Earley, DPT
• Eastport Chiropractic, LLC

• Family Medicine Physician in Lees Summit, MO
• Providers in Lees 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 Jul 25, 2013; 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.