Active NPI
Mark Walter Deroo, MD
- Pediatrics Physician
- Olathe, KS
National Provider Identifier
1982657516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 0427012
- Practice address
- 23450 College Blvd
Olathe, KS 66061-8702 - Phone
- (913) 764-7788
- Fax
- (913) 764-6088
- NPI assigned
- May 17, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 0427012 | KS | Primary |
Addresses
Primary practice location
23450 College Blvd
Olathe, KS 66061-8702
Mailing address
23450 College Blvd
Olathe, KS 66061-8702
Phone (913) 764-7788
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100293370E | Medicaid | KS |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0427012 | KS | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313712000000",
"number": "1982657516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23450 COLLEGE BLVD",
"city": "OLATHE",
"state": "KS",
"postal_code": "660618702",
"telephone_number": "913-764-7788",
"fax_number": "913-764-6088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23450 COLLEGE BLVD",
"city": "OLATHE",
"state": "KS",
"postal_code": "660618702",
"telephone_number": "913-764-7788",
"fax_number": "913-764-6088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEROO",
"first_name": "MARK",
"middle_name": "WALTER",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-17",
"last_updated": "2011-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "KS",
"license": "0427012",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100293370E",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Olathe, KS
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- John Allen Derington, MS, ATC, LAT
- Angela Elizabeth Desimone, M.S.W., C.S.W
- Destiny Care Homes Inc
- Sarah K Dettmer, M.S.ED., M.S., PLPC
- Amy Lynn Dewey, CPTA
- Ezhilarasi Dharmalingam, NP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.