JERRY L OLD (NPI# 1285731752) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285731752 |
| Entity Type | Individual |
| Full Name | JERRY L OLD |
| Credential | M.D. |
| Practice Address |
15329 W 95th St Lenexa KS 66219-1262 |
| Practice Telephone | 9135991125 |
| Practice Fax Number | 9135993554 |
| Mailing Telephone | 9135991125 |
| Mailing Fax Number | 9135993554 |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 207Q00000X | Family Medicine | 04-16260 | KS | Allopathic & Osteopathic Physicians |
| X | 2081H0002X |
Physical Medicine & Rehabilitation Specialization: Hospice and Palliative Medicine |
04-16260 | KS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | BCBS KANSAS CITY | 32423014 | 01 |
| KS | FIRSTGUARD | 614032 | 01 |
| Street Address |
15329 W 95TH ST |
| City | LENEXA |
| State | KS |
| Zip Code | 66219-1262 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700157070 | Faith Home Health & Hospice, LLC | Home Health | 15329 W 95th St, Lenexa, KS 66219-1262 | 2012-01-19 |
| 1548428402 | Hospice Care of Kansas LLC | Hospice Care, Community Based | 15329 W 95th St, Lenexa, KS 66219-1262 | 2008-05-28 |
| 1760573414 | Melissa L Conner | Nurse Practitioner | 15329 W 95th St, Lenexa, KS 66219-1262 | 2006-09-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902376205 | Daniel Wickham | Social Worker | 16979 W 94th St, Lenexa, KS 66219 | 2018-11-29 |
| 1851884472 | Amy Smith | Counselor | 16979 W. 94th Street, Lenexa, KS 66219 | 2018-06-08 |
| 1184124422 | Bellatore Recovery | Counselor | 16979 W 94th St Suite D, Lenexa, KS 66219 | 2018-02-13 |
| 1467980581 | Emma Lee | Speech-Language Pathologist | 15301 W 87th St Pkwy Suite 200, Lenexa, KS 66219 | 2017-06-02 |
| 1912440140 | Kathryn Leigh Hanson | Marriage & Family Therapist | 16979 W. 94th St, Lenexa, KS 66219 | 2016-11-20 |
| 1134585144 | Kelly Callaway | Chiropractor | 8724 Bourgade Ave, Lenexa, KS 66219 | 2016-01-06 |
| 1710369277 | Darcy Carlstedt | Physical Therapist | 15301 W. 87th St., Suite 200, Lenexa, KS 66219 | 2015-06-22 |
| 1215336011 | Whitney Rae Lang | Dietitian, Registered | 9202 Legler Cir Apartment 381, Lenexa, KS 66219 | 2014-08-18 |
| 1184037509 | Mh Health of Kansas, Pa | Nurse Practitioner | 8950 Renner Blvd, C/o Perceptive Software Health Center, Lenexa, KS 66219 | 2014-06-03 |
| 1730507039 | Jodie Beth Pafunda | Occupational Therapist | 9370 Scarborough St. Apt. 12106, Lenexa, KS 66219 | 2014-04-03 |
| Find all providers in zip 66219 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164052973 | Theory Health Kansas LLC | Family Medicine | 10000 Marshall Dr, Lenexa, KS 66215-1244 | 2020-01-21 |
| 1427412485 | Brooke Varnum | Family Medicine | 8700 Bourgade St Ste 2, Lenexa, KS 66219-1440 | 2016-04-06 |
| 1487998985 | Bassam Khulusi | Family Medicine | 11142 Thompson Ave, Lenexa, KS 66219-2301 | 2012-11-21 |
| 1871771469 | Stephanie Angela Crane | Family Medicine | 9300 Meadowview Dr., Lenexa, KS 66109-7288 | 2008-02-06 |
| 1174720148 | Erin Christine-noel Griffeth | Family Medicine | 20607 W 88th St, Lenexa, KS 66220-3367 | 2007-07-02 |
| 1124146337 | Lill Family Medicine Center, Inc | Family Medicine | 15325 W 95th St, Lenexa, KS 66219-1262 | 2007-03-26 |
| 1104919505 | Angelique' C Pritchett | Family Medicine | 12210 W 87th Street Pkwy, Suite 135, Lenexa, KS 66215-2812 | 2006-09-30 |
| 1184668279 | William John Hendricks | Family Medicine | 8700 Bourgade St, Suite 2, Lenexa, KS 66219-1440 | 2006-06-16 |
| 1154374106 | Lynne Ann Holz | Family Medicine | 12324 W 101st Ter, Lenexa, KS 66215-1808 | 2006-05-19 |
| 1336192442 | Dennis M. Jensen | Family Medicine | 23351 Prairie Star Pkwy Ste A245, Lenexa, KS 66227-7301 | 2006-05-18 |
| Find all providers in LENEXA | ||||
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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.