Basic Information
Provider Information | |||||||||
NPI: | 1942511233 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AUSMUS | ||||||||
FirstName: | ANDREW | ||||||||
MiddleName: | MICHAEL | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2401 GILLHAM RD. | ||||||||
Address2: | PROVIDER ENROLLMENT | ||||||||
City: | KANSAS CITY | ||||||||
State: | MO | ||||||||
PostalCode: | 641084619 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8167015200 | ||||||||
FaxNumber: | 8163029939 | ||||||||
Practice Location | |||||||||
Address1: | 2401 GILLHAM RD | ||||||||
Address2: |   | ||||||||
City: | KANSAS CITY | ||||||||
State: | MO | ||||||||
PostalCode: | 641084619 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8162343000 | ||||||||
FaxNumber: | 8163029939 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/01/2010 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2010019820 | MO | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208000000X | 2010019820 | MO | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 2080P0203X | 2017014403 | MO | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
ID Information
ID | Type | State | Issuer | Description | 1942511233 | 05 | WI |   | MEDICAID |