Providence Medical Group

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

Legal business name

PROVIDENCE MEDICAL GROUP

Practice address

8919 Parallel Pkwy Ste 555
Kansas City, KS 66112-3628

Phone

(913) 596-3930

NPI assigned

Nov 25, 2019

Last updated

Nov 26, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Diedre McDaniel, NA

Title

Medical Staff Office

Phone

(913) 596-4000

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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.

• Robert W Grimes Jr., PA-C

  • Surgical Physician Assistant
  • Kansas City, KS
  • NPI 1598741472
  NPD

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

{
    "created_epoch": "1574640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574726400000",
    "number": "1952947939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8919 PARALLEL PKWY STE 555",
            "city": "KANSAS CITY",
            "state": "KS",
            "postal_code": "661123628",
            "telephone_number": "913-596-3930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8919 PARALLEL PKWY STE 555",
            "city": "KANSAS CITY",
            "state": "KS",
            "postal_code": "661123628",
            "telephone_number": "913-596-3930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-25",
        "last_updated": "2019-11-26",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "DIEDRE",
        "authorized_official_title_or_position": "MEDICAL STAFF OFFICE",
        "authorized_official_telephone_number": "913-596-4000",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "NA"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1598741472",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Prospera, LLC.
• Cormac Prosser, MD
• Providence Cardiothoracic Associates
• Providence Care Inc
• Providence Medical Center, Inc
• Providence Place, Inc.
• Patrick P Pruitt, LCSW
• Stephanie Lynn Prusa, DENTAL HYGIENIST
• Hannah Prymek, ATC
• Elizabeth Kent Pryor, MD

• Sports Medicine (Orthopaedic Surgery) Physician in Kansas City, KS
• Providers in Kansas City, KS by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2019; 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.