NPIMap

Organization Active NPI

Waldo Wellness Group PC

  • Family Medicine Physician
  • Kansas City, MO
National Provider Identifier
1972761187
Registry record updated Mar 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
33655 Issued in MO
Legal business name
WALDO WELLNESS GROUP PC
Practice address
7210 Wornall Rd
Kansas City, MO 64114-1345
Phone
(816) 333-2533
Fax
(816) 333-2586
NPI assigned
May 26, 2008
Last updated
Mar 7, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2013

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

Authorized official

Name
Dr. Randy Lee Kellerman, D.C.NPI 1790973881
Title
President/Owner
Phone
(816) 333-2533

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2007030924 MO
Family Medicine Physician 207Q00000X 33655 MO Primary
Physical Therapist 225100000X 20110310891 MO

Addresses

Primary practice location

7210 Wornall Rd
Kansas City, MO 64114-1345

Mailing address

7210 Wornall Rd
Kansas City, MO 64114-1345
Phone (816) 333-2533

Other names 1

  • Waldo Chiropractic Group Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080603000353 MO Part B Supplier - Clinic/Group Practice 5799855797 Receives reassigned benefits from 3 practitioners
Practice locations: Kansas City, MO

National Provider Directory

National Provider Directory

Locations

7210 Wornall Rd
Kansas City, MO 64114
Phone (816) 333-2533

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1211760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362614400000",
    "number": "1972761187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7210 WORNALL RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641141345",
            "telephone_number": "816-333-2533",
            "fax_number": "816-333-2586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7210 WORNALL RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641141345",
            "telephone_number": "816-333-2533",
            "fax_number": "816-333-2586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALDO WELLNESS GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-26",
        "last_updated": "2013-03-07",
        "status": "A",
        "authorized_official_last_name": "KELLERMAN",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "816-333-2533",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2007030924",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "33655",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "20110310891",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waldo Chiropractic Group",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Kansas City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2013; 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.