JEFFREY A HICKLIN (NPI# 1083729222) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083729222 |
| Entity Type | Individual |
| Full Name | JEFFREY A HICKLIN |
| Credential | MD |
| Practice Address |
9100 W 74th St Shawnee Mission KS 66204-4004 |
| Mailing Address |
8000 W 110th St Ste 150 Overland Park KS 66210-2338 |
| Practice Telephone | 9136762310 |
| Mailing Telephone | 9135996777 |
| Mailing Fax Number | 9135993955 |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2013-08-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
04-27554 | KS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | 100312920C | 05 | |
| MO | 203938212 - SMMC | 05 | |
| KS | BCBS | 24884043 | 01 |
| Street Address |
9100 W 74TH ST |
| City | SHAWNEE MISSION |
| State | KS |
| Zip Code | 66204-4004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386641702 | Gregory Jan Strohs | Pharmacist | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2005-06-30 |
| 1235767229 | Sarah-grace Miller Hamm | Registered Nurse | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2020-03-27 |
| 1174159362 | Lindsey Ann Bagby | Registered Nurse | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2020-03-19 |
| 1285260570 | Kathleen Ann Henderson | Clinical Nurse Specialist | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2020-03-18 |
| 1295368140 | Alex M Whitehill | Registered Nurse | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2020-02-19 |
| 1467085993 | Rogelio Alfonso Morin | Specialist/Technologist, Other | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2020-02-12 |
| 1891326641 | Christopher J White | Registered Nurse | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2020-01-30 |
| 1750947271 | Patrick J Patterson | Registered Nurse | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2019-05-10 |
| 1164985461 | Ashley M Kane | Registered Nurse | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2019-04-12 |
| 1174085765 | Rachel M Meredith | Registered Nurse | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2019-04-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326652405 | Avenue 81 Iaop | Assisted Living Facility | 8055 Metcalf Ave, Overland Park, KS 66204 | 2020-09-04 |
| 1487160255 | Femme Focus, L.L.C. | Clinic/Center | 7927 Floyd, Rm 5, Home Family Holistic Center, Overland Park, KS 66204 | 2017-12-15 |
| 1427577469 | Linda Kay Mufich-knopp | Physical Therapist | Femme Focus, L.L.C. In The Home Family Holistic Center, 7927 Floyd Street, Suite 5, Overland Park, KS 66204 | 2017-09-11 |
| 1700304789 | Kalli Dee Karmann | Occupational Therapy Assistant | 6814 W 72nd St, Overland Park, KS 66204 | 2017-08-30 |
| 1164951786 | Daniel Collins | Physical Therapist | 10000 W. 75th St. Ste. 250, Merriam, KS 66204 | 2017-06-07 |
| 1942686530 | Anna Katheryn Grantham | Speech-Language Pathologist | 10000 W. 75th St., Suite 250, Merriam, KS 66204 | 2015-08-05 |
| 1700262680 | Maple Hills Healthcare, Inc. | Skilled Nursing Facility | 7600 Antioch Rd, Overland Park, KS 66204 | 2015-08-03 |
| 1104211085 | John Brainard | Pediatrics | 8901 W 74th St Ste 10, Shawnee Mission, KS 66204 | 2015-03-30 |
| 1477941318 | Shelley Watts | Occupational Therapy Assistant | 6712 W 72nd Street, Overland Park, KS 66204 | 2014-12-30 |
| 1578963369 | James Aaron Mitchum | Counselor | 7923 Santa Fe Dr, Overland Park, KS 66204 | 2014-08-28 |
| Find all providers in zip 66204 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164546479 | Kavita Chowdary Gorantla | Radiology | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2007-03-19 |
| 1265527113 | Mark S Reinsel | Radiology | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2006-10-04 |
| 1063507853 | John Yungmeyer | Radiology | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2006-10-04 |
| 1639264443 | Mark Idstrom | Radiology | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2006-10-04 |
| 1447365630 | Robert E Moffat | Radiology | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2006-08-20 |
| 1164537346 | Richard D Miller | Radiology | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2006-08-20 |
| 1568482669 | Michael E Brun | Radiology | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2006-07-20 |
| 1184644288 | Michael W Dennis | Radiology | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2006-07-20 |
| 1063432169 | Michael J Gaughan | Radiology | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2006-07-20 |
| 1396762746 | Andrew Harmon | Radiology | 9100 W 74th St, Shawnee Mission, KS 66204-4004 | 2006-07-15 |
| Find all providers in SHAWNEE MISSION | ||||
| City | SHAWNEE MISSION |
| Zip Code | 66204 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.