Marandapalli R Jayaram, MD
Individual provider Active NPI Pediatrics Physician · Kansas City, KS
NPI 1922056423 · NPPES record last updated May 21, 2021
Key facts
- NPI
- 1922056423
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 0415262 (KS)
- Practice address
- 2040 Hutton Rd
Suite 102
Kansas City, KS 66109-4566 - Phone
- (913) 299-3700
- Fax
- (913) 299-3050
- NPI assigned
- May 5, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0415262 | KS | MD | Pediatric Cardiology Physician |
Interoperability endpoints
- marandapallijayaram@smgks.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Cardiology Physician | 2080P0202X | 0415262 | KS | |
| Pediatrics Physician | 208000000X | 0415262 | KS | Yes |
Addresses
Primary practice location
2040 Hutton Rd
Suite 102
Kansas City, KS 66109-4566
Mailing address
5675 Roe Blvd
Ste 100
Roeland Park, KS 66205-2538
Phone (913) 432-2080
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100093650D | Medicaid | KS | |
| 100216770C | Medicaid | KS |
Other providers in Kansas City, KS
- Jason Wiltshire, MD, PA
- Nimra Javaid
- Melissa Javellana
- Jeffrey John Villareal Javier
- Omar Jawdat
- Jayhawk Primary Care Inc
- Jayhawk Primary Care Inc
- Jayhawk Primary Care Inc
- Jayhawk Primary Care Inc
- Jayhawk Primary Care Inc
All providers in Kansas City, KS · Pediatrics Physician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 21, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.