Active NPI
Marissa D Lutzkanin, PA-C
- Gastroenterology Physician
- Shawnee, KS
National Provider Identifier
1972289627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 15-02764
- Practice address
- 7230 Renner Road
Shawnee, KS 66217 - Phone
- (913) 962-2122
- Fax
- (913) 962-2422
- NPI assigned
- Jun 27, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 15-02764 | KS | Primary |
Addresses
Primary practice location
7230 Renner Road
Shawnee, KS 66217
Mailing address
7230 Renner Road
Shawnee, KS 66217
Phone (913) 962-2122
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15-02764 | KS | MD | Gastroenterology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prime Healthcare Physician Services - Providence Inc | Gastroenterology | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Physician
- Shawnee, KS
- NPI 1356683213
Gastroenterology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691452800000",
"number": "1972289627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7230 RENNER ROAD",
"city": "SHAWNEE",
"state": "KS",
"postal_code": "66217",
"telephone_number": "913-962-2122",
"fax_number": "913-962-2422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7230 RENNER ROAD",
"city": "SHAWNEE",
"state": "KS",
"postal_code": "66217",
"telephone_number": "913-962-2122",
"fax_number": "913-962-2422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUTZKANIN",
"first_name": "MARISSA",
"middle_name": "D",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-27",
"last_updated": "2023-08-08",
"certification_date": "2023-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "KS",
"license": "15-02764",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.