DR. JAY R PEMBERTON (DO) – Emergency Medicine Physician, NPI 1700878907
Emergency Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,351 EMERGENCY MEDICINE in MO
Provider Addresses for DR. JAY R PEMBERTON (DO)
Jack in the Box, South 18th Street, Kansas City, Wyandotte County, Kansas, 66102, United States
KANSAS CITY, MO 641414965
Phone: (913) 234-1350
Type: Mailing
201 W R D MIZE RD
BLUE SPRINGS, MO 640142518
Phone: (816) 228-5900
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-01-24
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050124000114 | I | Emergency Medicine | MO | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99285 | Emergency department visit with high level of medical decision making | 101 | 99 | $0 |
| 99284 | Emergency department visit with moderate level of medical decision making | 61 | 58 | $0 |
| 93042 | Electrocardiogram (ecg) 1 to 3 leads with review by physician only | 28 | 27 | $0 |
| 99291 | Critical care, first 30-74 minutes | 14 | 14 | $0 |
Insurance plans in this area (ZIP 64141)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Certified Registered Nurse Anesthetist (Crna) | MO | |
| Nurse Practitioner | MO | |
| Pain Management, Anesthesiology | KS | |
| Internal Medicine | MO | |
| - | KS | |
| Family Practice | MO | |
| Emergency Medicine | OK | |
| O B S T E T R I C S/ G Y N E C O L O G Y | MO | |
| Nurse Practitioner | KS | |
| Emergency Medicine | MO |
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