NPIMap

Organization Active NPI

Shawnee Mission Medical Center, Inc.

Doing business as AdventHealth Centra Care

  • Urgent Care Clinic/Center
  • Shawnee, KS
National Provider Identifier
1942317854
Registry record updated Nov 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
SHAWNEE MISSION MEDICAL CENTER, INC.
Doing business as
AdventHealth Centra Care
Practice address
11245 Shawnee Mission Parkway
Shawnee, KS 66203-3333
Phone
(913) 268-4455
Fax
(913) 268-4493
NPI assigned
Aug 24, 2006
Last updated
Nov 18, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
SHAWNEE MISSION MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2019

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

Authorized official

Name
Karsten G Randolph
Title
Exec VP & Cfo
Phone
(913) 676-2152

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X

Addresses

Primary practice location

11245 Shawnee Mission Parkway
Shawnee, KS 66203-3333

Mailing address

11245 Shawnee Mission Parkway
Shawnee, KS 66203-3333
Phone (913) 268-4455

Other names 1

  • AdventHealth Centra Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170209000848 KS Part B Supplier - Clinic/Group Practice 1153239298 Receives reassigned benefits from 64 practitioners
Practice locations: Olathe, KS; Overland Park, KS; Shawnee, KS

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Georgetown Family Cate

Locations

15983 Coll Ctr Dr
Chicago, IL 60693

15983 Collections Ctr Dr
Chicago, IL 60693

14744 W 119th St
Olathe, KS 66062
Phone (913) 839-1759

11367 W 95th St
Shawnee Mission, KS 66214
Phone (913) 888-1151

Practitioners & affiliated clinicians

Practitioners 116

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 116

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574035200000",
    "number": "1942317854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11245 SHAWNEE MISSION PARKWAY",
            "city": "SHAWNEE",
            "state": "KS",
            "postal_code": "662033333",
            "telephone_number": "913-268-4455",
            "fax_number": "913-268-4493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11245 SHAWNEE MISSION PARKWAY",
            "city": "SHAWNEE",
            "state": "KS",
            "postal_code": "662033333",
            "telephone_number": "913-268-4455",
            "fax_number": "913-268-4493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWNEE MISSION MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHAWNEE MISSION MEDICAL CENTER, INC.",
        "enumeration_date": "2006-08-24",
        "last_updated": "2019-11-18",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "KARSTEN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "EXEC VP & CFO",
        "authorized_official_telephone_number": "913-676-2152"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AdventHealth Centra Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AdventHealth Centra Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shawnee, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2019; 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.