KELLY B. PENDERGRASS M.D.
NPI 1639140221
Internal Medicine - Hematology & Oncology in Lees Summit, MO

Q: What is Kelly Pendergrass's NPI number?

The NPI number for Kelly Pendergrass is 1639140221. It was assigned to this individual provider in the NPPES registry on January 31, 2006.

Q: What is Kelly Pendergrass's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Hematology & Oncology, with taxonomy code 207RH0003X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Pendergrass was last updated on April 17, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 31, 2006

4881 NE GOODVIEW CIR, LEES SUMMIT, MO 64064(913) 574-2350(913) 574-2413 Get Directions Write a Review

NPPES record last updated: April 17, 2018. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 17, 2018, Jun 23, 2016 (2 updates tracked since 2016).

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About Kelly B. Pendergrass M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY B. PENDERGRASS M.D. (NPI 1639140221) is an individual hematology & oncology provider in Lees Summit, Missouri, licensed in Missouri (R6A95) and active in the NPI registry since January 2006.

NPPES Registry Identity

NPI1639140221

Entity TypeIndividualMale

Primary Taxonomy207RH0003X

Provider Legal NameKELLY B. PENDERGRASSCredential: M.D.

Location Address4881 NE GOODVIEW CIRLees Summit, MO 64064-1996

Mailing Address9200 Indian Creek Pkwy, Building 9, Suite 300Overland Park, KS 66210-2002 · (913) 574-2800 · Fax (913) 574-2336

Phone(913) 574-2350

Fax(913) 574-2413

Sole ProprietorNo

Enumeration DateJanuary 31, 2006

Last NPPES UpdateApril 17, 20182 updates tracked since enumeration

✔ NPI 1639140221 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Hematology & OncologyAllopathic & Osteopathic Physicians

Taxonomy Code207RH0003X

Licenses✔ Licensed in MO · R6A95✔ Licensed in KS · 04-25043

Definition

An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

4881 NE GOODVIEW CIR, Lees Summit, MO 64064

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Other Identifiers 2

Medicaid100364750BKS

Medicaid1639140221MO

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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Pharmacy (Clinic Pharmacy)