JAYHAWK PRIMARY CARE INC (NPI# 1417919283) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417919283 |
| Entity Type | Organization |
| Organization Name | JAYHAWK PRIMARY CARE INC |
| Other Organization Name | CREEKWOOD FAMILY CARE |
| Practice Address |
6420 N Prospect Ave Gladstone MO 64119-1530 |
| Mailing Address |
2330 Shawnee Mission Pkwy Medical Administrative Services of Ku Med. Ste. 312 Westwood KS 66205-2005 |
| Practice Telephone | 9139459700 |
| Practice Fax Number | 9139459707 |
| Mailing Telephone | 9139455614 |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2018-06-13 |
| Authorized Official Name | CARRIE JORDAN (CHIEF PRACTICE EXECUTIVE) |
| Authorized Official Telephone | 9139455592 |
| Is Organization Subpart | Y |
| Parent Organization Name | JAYHAWK PRIMARY CARE INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | BCBS GROUP NUMBR | 10663011 | 01 |
| Other Name | Type Code |
|---|---|
| CREEKWOOD FAMILY CARE | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164813879 | Jayhawk Primary Care Inc | Clinic/Center | 1403 Grand Blvd, Kansas City, MO 64106 | 2015-02-17 |
| 1356308878 | Jayhawk Primary Care Inc | Family Medicine | 6515 N Cosby Ave, Picture Hills Family Medicine, Kansas City, MO 64151-2380 | 2006-04-27 |
| 1790742765 | Jayhawk Primary Care Inc | Family Medicine | 4721 S Cliff Ave, Family Care of Independence Suite 200, Independence, MO 64055-7016 | 2006-04-26 |
| 1831685353 | Jayhawk Primary Care Inc | Family Medicine | 1403 Grand Blvd, Kansas City, MO 64106-2917 | 2018-07-09 |
| 1487062592 | Jayhawk Primary Care Inc | Clinic/Center | 3901 Rainbow Blvd, University of Kansas Hospital Urgent Care / G110 Delp, Kansas City, KS 66160-0001 | 2014-08-01 |
| 1063847812 | Jayhawk Primary Care Inc | Internal Medicine | 10787 Nall Ave, Ste 310, Overland Park, KS 66211-1375 | 2013-09-12 |
| 1326383274 | Jayhawk Primary Care Inc | Family Medicine | 4810 State Ave, State Avenue Health Care, Kansas City, KS 66102-1748 | 2012-12-04 |
| 1932460177 | Jayhawk Primary Care Inc | Family Medicine | 10777 Nall Ave, Ste 140, Overland Park, KS 66211-1362 | 2012-06-05 |
| 1245521814 | Jayhawk Primary Care Inc | Durable Medical Equipment & Medical Supplies | 7405 Renner Road, Ku Medwest Therapy, Shawnee, KS 66217-0000 | 2011-04-29 |
| 1982845970 | Jayhawk Primary Care Inc | Internal Medicine | 10787 Nall Ave, Ste. 310, Overland Park, KS 66211-0000 | 2009-03-20 |
| Street Address |
6420 N PROSPECT AVE |
| City | GLADSTONE |
| State | MO |
| Zip Code | 64119-1530 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346872173 | Ana M Newell | Registered Nurse | 6420 N Prospect Ave, Gladstone, MO 64119-1530 | 2020-02-10 |
| 1235576752 | Justin Scott Lawing | Family Medicine | 6420 N Prospect Ave, Gladstone, MO 64119 | 2013-05-23 |
| 1376808022 | Jessica Treece | Family Medicine | 6420 N Prospect Ave, Gladstone, MO 64119-1530 | 2012-07-09 |
| 1568583953 | Jayhawk Primary Care Inc | Clinic/Center | 6420 N Prospect Ave, Gladstone, MO 64119 | 2007-04-03 |
| 1407932585 | Diana Lynne Rodenberg | Dietitian, Registered | 6420 N Prospect Ave, Gladstone, MO 64119-1530 | 2006-10-31 |
| 1821024688 | Kerri Lynn Keberlein-lynn | Nurse Practitioner | 6420 N Prospect Ave, Gladstone, MO 64119 | 2006-06-24 |
| 1174559942 | Robert E. Dattilio | Family Medicine | 6420 N Prospect Ave, Gladstone, MO 64119 | 2006-06-24 |
| 1871538074 | Robert W. Drogan | Family Medicine | 6420 N Prospect Ave, Gladstone, MO 64119 | 2006-06-19 |
| 1538107602 | Christina M. Panis Miller | Physician Assistant | 6420 N Prospect Ave, Gladstone, MO 64119 | 2006-06-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255978227 | Heath Bryan Coleman, Dds of Missouri II, LLC | Dentist | 5363 Ne Antioch Rd, Kansas City, MO 64119 | 2019-12-09 |
| 1528525219 | Lifestreams, LLC | Home Health | 5229 Ne 56th Place, Kansas City, MO 64119 | 2019-02-28 |
| 1740639798 | Daniel Sucher | Dentist | 5416 Ne Antioch Rd, Kansas City, MO 64119 | 2016-06-10 |
| 1902266885 | Mia Depriest | Pharmacy Technician | 4838 N Manchester Ave, Kansas City, MO 64119 | 2016-03-04 |
| 1376929976 | Abigail Blair | Physical Therapist | 8121 Ne 69 Highway, Kansas City, MO 64119 | 2015-08-05 |
| 1508273939 | Morgan Shockey | Dentist | 244 E Us Hwy 69, Ste 101, Claycomo, MO 64119 | 2014-07-17 |
| 1184865990 | Laura F Hanna | Psychologist | 3100 Ne 83rd Street, Suite#1001, Kansas City, MO 64119 | 2009-03-09 |
| 1114110483 | Heintz-sight 20/20, Inc | Optometrist | 7201 North M-1 Hwy, Gladstone, MO 64119 | 2007-08-21 |
| 1356533194 | Levelup Kids, Inc. | Optometrist | 5416 Ne Antioch Road, Kansas City, MO 64119 | 2007-08-15 |
| 1275738932 | Renee Christine Springer | Physical Therapist | 2901 Ne 72nd St, Gladstone, MO 64119 | 2007-06-20 |
| Find all providers in zip 64119 | ||||
| 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 |
|---|---|---|---|---|
| 1982877841 | Cynthia M Worden | Family Medicine | 15 82nd Dr Ste 100, Gladstone, OR 97027-2550 | 2008-04-10 |
| 1316068919 | Sean Scott Harper | Family Medicine | 1105 Portland Ave Ste 2, Gladstone, OR 97027-2170 | 2007-04-02 |
| 1336281534 | Dr. J.a. Direnna Jr, P.C. | Family Medicine | 1 The Woodlands, Gladstone, MO 64119-1853 | 2007-02-13 |
| 1609884436 | Mary C Whitmer | Family Medicine | 128 Michigan Ave, Gladstone, MI 49837-1929 | 2006-08-04 |
| 1558399014 | Catherine Alpha Anderson | Family Medicine | 6651 N Oak Trfy Ste 3, Gladstone, MO 64118-3353 | 2006-06-30 |
| 1447298385 | Timothy C. Frey | Family Medicine | 5601 N. Antioch, Creekwood Family Care, Ste. 12, Gladstone, MO 64119 | 2006-06-03 |
| 1558901413 | Portland Adventist Medical Center | Family Medicine | 19220 Mcloughlin Blvd, Gladstone, OR 97027-2642 | 2020-01-08 |
| 1154877157 | Gladstone Family Care, LLC | Family Medicine | 6717 N Oak Trfy, Gladstone, MO 64118-3346 | 2016-08-30 |
| 1235576752 | Justin Scott Lawing | Family Medicine | 6420 N Prospect Ave, Gladstone, MO 64119 | 2013-05-23 |
| 1376808022 | Jessica Treece | Family Medicine | 6420 N Prospect Ave, Gladstone, MO 64119-1530 | 2012-07-09 |
| Find all providers in GLADSTONE | ||||
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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.