DR. ALLEN BRUCE JETMORE (NPI# 1093725111) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093725111 |
| Entity Type | Individual |
| Full Name | DR. ALLEN BRUCE JETMORE |
| Credential | MD |
| Practice Address |
11111 Nall Ave Suite 116 Leawood KS 66211-1924 |
| Practice Telephone | 9134510600 |
| Practice Fax Number | 9134510601 |
| Mailing Telephone | 9134510600 |
| Mailing Fax Number | 9134510601 |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2011-08-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 0424436 | KS | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | BCBS OF KANSAS CITY | 18198056 | 01 |
| Street Address |
11111 NALL AVE SUITE 116 |
| City | LEAWOOD |
| State | KS |
| Zip Code | 66211-1924 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942209366 | Lynn Daniel Ketchum | Specialist | 11111 Nall Ave, Suite 114, Leawood, KS 66211-1925 | 2005-07-18 |
| 1508262999 | Deborah L. Carle, Ph.d., LLC | Psychologist | 11111 Nall Ave, Site 224, Leawood, KS 66211-1924 | 2014-11-12 |
| 1356783146 | Special Care Dental of Kansas, LLC | Dentist | 11111 Nall Ave, Suite 100, Leawood, KS 66211-1924 | 2013-07-23 |
| 1790127512 | Special Care Dental of Missouri LLC | Dental Hygienist | 11111 Nall Ave, Suite 100, Leawood, KS 66211-1924 | 2013-07-22 |
| 1154769735 | Elh Network, LLC | Preferred Provider Organization | 11111 Nall Ave, Suite 220, Leawood, KS 66211-1924 | 2013-06-05 |
| 1215253570 | Angela Giegerich | Nurse Practitioner | 11111 Nall Ave, Suite 222, Leawood, KS 66211-1924 | 2010-04-12 |
| 1306177696 | Ilene Beth Grunspan | Social Worker | 11111 Nall Ave, Suite 103, Leawood, KS 66211-1924 | 2010-01-26 |
| 1447486642 | Ian James Krusich | Dentist | 11111 Nall Ave, 106, Leawood, KS 66211-1924 | 2009-06-03 |
| 1750563458 | Lynn D. Ketchum, M.d. | Plastic Surgery | 11111 Nall Ave, Ste 114, Leawood, KS 66211-1625 | 2007-12-04 |
| 1861607657 | Robert R. Edwards | Dentist | 11111 Nall Ave, Suite 114, Leawood, KS 66211-1620 | 2007-05-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336611821 | Baillie Rose Woydziak | Social Worker | 5805 W 110th Street, Overland Park, KS 66211 | 2018-12-20 |
| 1467920389 | Ku Medwest Ambulatory Surgery Center, LLC | Clinic/Center | 10720 Nall Avenue, Overland Park, KS 66211 | 2018-11-08 |
| 1235615931 | Janice Carollo | Physical Therapy Assistant | 11611 Granada Lane, Leawood, KS 66211 | 2018-07-16 |
| 1720572555 | Trevor Lee Elmer | Physical Therapist | 10777 Nall, 320 - Corporate Medical Plaza Building II, Overland Park, KS 66211 | 2018-06-15 |
| 1043746555 | Overland Park Surgical Suites, LLC | Clinic/Center | 6650 W 110th St Ste 300, Overland Park, KS 66211 | 2017-05-03 |
| 1619313665 | Vcphcs Xiv, LLC | Clinic/Center | 6331 W. 110th Street, Overland Park, KS 66211 | 2013-05-17 |
| 1528334950 | Scott Anthony Hardouin | Surgery | 5100 W 110th St Unit 300, Overland Park, KS 66211 | 2012-03-29 |
| 1386917003 | Children's Physical Therapy Associates | Physical Therapist | 6600 College Boulevard, Suite 307, Overland Park, KS 66211 | 2012-02-10 |
| 1871876250 | Amber Diane Dalzell | Social Worker | 10965 Granada Ln Ste 102, Overland Park, KS 66211 | 2011-09-22 |
| 1912298001 | Stephen Vincent Hiatt | Orthopaedic Surgery | 10701 Nall Avenue, Suite 200, Overland Park, KS 66211 | 2011-04-25 |
| Find all providers in zip 66211 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427407774 | Kally Germano | Specialist | 13121 Buena Vista St, Leawood, KS 66209-4145 | 2016-06-07 |
| 1629313093 | Howard Ellis | Specialist | 11615 Mohawk Ln, Leawood, KS 66211-2665 | 2012-12-11 |
| 1093048373 | Debra Marie Galvin | Specialist | 5033 W 117th St, Leawood, KS 66211-2053 | 2009-09-17 |
| 1053347831 | David P Halbach | Specialist | 12317 Wenonga Ln, Leawood, KS 66209-1436 | 2006-06-24 |
| 1013968007 | Jeffrey Rhodes Dillow | Specialist | 4801 W 135th St, Leawood, KS 66224-8901 | 2006-05-13 |
| 1164481735 | Advanced Cosmetic Surgery, P.a. | Specialist | 11401 Nall Ave, Leawood, KS 66211-1674 | 2006-03-21 |
| 1942209366 | Lynn Daniel Ketchum | Specialist | 11111 Nall Ave, Suite 114, Leawood, KS 66211-1925 | 2005-07-18 |
| 1366441966 | Associated Plastic Surgeons PC | Specialist | 11501 Granada Ln, Leawood, KS 66211-1454 | 2005-07-18 |
| 1780689885 | Daniel J Geha | Specialist | 8800 State Line Rd, Leawood, KS 66206-1553 | 2005-06-15 |
| 1508232083 | Sowjanya Duthuluru | Specialist | 11213 Nall Ave, Suite 100, Leawood, KS 66211-1833 | 2015-08-19 |
| Find all providers in LEAWOOD | ||||
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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.