PROVIDENCE MEDICAL GROUP - NPI 1952947939 - Orthopaedic Surgery in Kansas City, KS

Q: What is Providence Medical Group's NPI number?

The NPI number for Providence Medical Group is 1952947939. It was assigned to this organization in the NPPES registry on November 25, 2019.

Q: What is Providence Medical Group's specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery, specializing in Sports Medicine, with taxonomy code 207XX0005X.

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About Providence Medical Group NPPES

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

PROVIDENCE MEDICAL GROUP (NPI 1952947939) is a healthcare organization registered as a sports medicine in Kansas City, Kansas and active in the NPI registry since November 2019. The organization holds a CLIA Waiver certificate valid through December 18, 2027 and lists Diedre Mcdaniel, Medical Staff Office, as its authorized official.

NPPES Registry Identity

NPI1952947939

Entity TypeOrganization

Primary Taxonomy207XX0005X

Legal Business NamePROVIDENCE MEDICAL GROUP

Location Address8919 PARALLEL PKWY STE 555Kansas City, KS 66112-3628

Mailing Address8919 Parallel Pkwy Ste 555Kansas City, KS 66112-3628 · (913) 596-3930

Phone(913) 596-3930

Organization SubpartNo

Authorized OfficialDiedre McdanielMedical Staff Office · (913) 596-4000

Enumeration DateNovember 25, 2019

Last NPPES UpdateNovember 26, 2019

✔ NPI 1952947939 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOrthopaedic Surgery · Sports MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207XX0005X

Definition

An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries.

8919 PARALLEL PKWY STE 555, Kansas City, KS 66112

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Other Identifiers 1

Other1598741472KS · Npi

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 17D2070587

Providence Medical Group - Ob/Gyn · Kansas City, KS

Active · expires Dec 18, 2027

CLIA Number17D2070587

Laboratory TypePhysician Office

Certificate Effective DateDecember 19, 2025

Certificate Expiration DateDecember 18, 2027

Laboratory DirectorGina M. Petelin

Laboratory Phone(913) 596-4929

Laboratory LocationProvidence Medical Group - Ob/Gyn8101 Parallel Parkway Suite 200, Kansas City, KS 66112

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

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

LINDSEY FAY GRANT PA-C

Physician Assistant (Medical)