NPIMap

Individual provider Active NPI

Samuel Dean Brewster, M.D.

  • Family Medicine Physician
  • Harrisonville, MO
National Provider Identifier
1962491274
Registry record updated Mar 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2002015285 Issued in MO
Practice address
2820 E Rock Haven Road
Suite 210
Harrisonville, MO 64701
Phone
(816) 380-7470
Fax
(816) 380-3291
NPI assigned
Oct 19, 2005
Last updated
Mar 16, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2002015285 MO Primary

Addresses

Primary practice location

2820 E Rock Haven Road
Suite 210
Harrisonville, MO 64701

Mailing address

2820 E Rock Haven Road
Suite 210
Harrisonville, MO 64701
Phone (816) 380-7470

Other identifiers 2

IdentifierTypeStateIssuer
209193903MedicaidMO
34192014OtherBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040805000984 MO Practitioner - Family Practice 8628049129 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Missouri, Kansas City, School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cass Regional Medical CenterGroup PAC ID 7517853781, 44 clinicians

Practice addresses (Care Compare)

2820 E Rock Haven Rd
210 Harrisonville Medical Clinic
Harrisonville, MO 64701-4414
Phone (816) 380-7470

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2002015285MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cass Regional Medical Center CurrentSince Jul 5, 2004 Accepting new patients
Cass Regional Medical Center CurrentSince Jul 5, 2004 Accepting new patients
Cass Regional Medical Center Past Accepting new patients
Cass Medical Center Past Accepting new patients

Locations

103 Oriole St
Harrisonville, MO 64701
Phone (816) 884-3244

2800 E Rock Haven Rd
Harrisonville, MO 64701
Phone (816) 380-3474

2820 E Rock Haven Rd
Ste 210
Harrisonville, MO 64701
Phone (816) 380-7470

1601 N State Route 7
Pleasant Hill, MO 64080
Phone (816) 540-2111

Interoperability endpoints

  • Direct secure messaging: samuel.brewster@cassregional.direct-ci.com

Organizations & group practices 4

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

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300233600000",
    "number": "1962491274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 E ROCK HAVEN ROAD",
            "address_2": "SUITE 210",
            "city": "HARRISONVILLE",
            "state": "MO",
            "postal_code": "64701",
            "telephone_number": "816-380-7470",
            "fax_number": "816-380-3291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 E ROCK HAVEN ROAD",
            "address_2": "SUITE 210",
            "city": "HARRISONVILLE",
            "state": "MO",
            "postal_code": "64701",
            "telephone_number": "816-380-7470",
            "fax_number": "816-380-3291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREWSTER",
        "first_name": "SAMUEL",
        "middle_name": "DEAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-19",
        "last_updated": "2011-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2002015285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209193903",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "34192014",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrisonville, MO

Sources for this page

Verify at the official NPI Registry.