NPIMap

Organization Active NPI

Mid America Senior Management LLC

  • Internal Medicine Physician
  • Tonganoxie, KS
National Provider Identifier
1942356977
Registry record updated Jul 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
04-21601 Issued in KS
Legal business name
MID AMERICA SENIOR MANAGEMENT LLC
Practice address
21107 Donahoo Rd
Tonganoxie, KS 66086-4153
Phone
(913) 742-4084
Fax
(913) 742-4086
NPI assigned
Jan 25, 2007
Last updated
Jul 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2011

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

Authorized official

Name
Anna Marie Mathes
Title
Practice Administrator
Phone
(913) 742-4084

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 04-21601 KS Primary

Addresses

Primary practice location

21107 Donahoo Rd
Tonganoxie, KS 66086-4153

Mailing address

PO Box 996
Tonganoxie, KS 66086-0996
Phone (913) 742-4084

Other identifiers 1

IdentifierTypeStateIssuer
100347530AMedicaidKS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050707000856 KS Part B Supplier - Clinic/Group Practice 6406827435 Receives reassigned benefits from 8 practitioners
Practice locations: Overland Park, KS; Olathe, KS; Priairie Village, KS; Richmond, KS; Shawnee, KS; Spring Hill, KS; Tonganoxie, KS; Bonner Springs, KS…

National Provider Directory

National Provider Directory

Locations

9100 Park St
#202B
Lenexa, KS 66215
Phone (913) 438-4286

751 N Somerset Ter
#S
Olathe, KS 66062
Phone (913) 829-4663

791 N Somerset Ter
#N
Olathe, KS 66062
Phone (913) 829-1403

11701 Nieman Rd
Overland Park, KS 66210
Phone (913) 345-1032

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311206400000",
    "number": "1942356977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 996",
            "city": "TONGANOXIE",
            "state": "KS",
            "postal_code": "660860996",
            "telephone_number": "913-742-4084",
            "fax_number": "913-742-4086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21107 DONAHOO RD",
            "city": "TONGANOXIE",
            "state": "KS",
            "postal_code": "660864153",
            "telephone_number": "913-742-4084",
            "fax_number": "913-742-4086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID AMERICA SENIOR MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2011-07-21",
        "status": "A",
        "authorized_official_last_name": "MATHES",
        "authorized_official_first_name": "ANNA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "913-742-4084"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "04-21601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100347530A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tonganoxie, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; 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.