KANSAS PAIN MANAGEMENT – Pain Medicine (Anesthesiology) Physician, NPI 1104929546
Pain Medicine (Anesthesiology) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for KANSAS PAIN MANAGEMENT
711 Marshall St
Leavenworth, KS 660483235
Phone: (913) 339-9437
Fax: (913) 339-9538
Type: Location
373 W 101st Ter
Kansas City, MO 641144498
Phone: (913) 339-9437
Fax: (913) 339-9538
Type: Location
3550 S 4th St
Leavenworth, KS 660485071
Phone: (913) 339-9437
Fax: (913) 339-9538
Type: Location
10601 Quivira Rd Ste 100
Overland Park, KS 662152320
Phone: (913) 339-9437
Fax: (913) 339-9538
Type: Location
1220 Biltmore Dr
Lawrence, KS 660491995
Phone: (913) 339-9437
Fax: (913) 339-9437
Type: Location
10550 Quivira Rd
Overland Park, KS 662152306
Phone: (913) 339-9437
Fax: (913) 339-9538
Type: Location
1301 S Main St
Ottawa, KS 660673598
Phone: (913) 339-9437
Fax: (913) 339-9538
Type: Location
Quivira Road, Overland Park, Johnson County, Kansas, 66210, United States
OVERLAND PARK, KS 662101207
Phone: (913) 339-9437
Fax: (913) 339-9538
Type: Mailing
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: 2019-02-01
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-02-29 (834 days ago).
Enrollment records
3
Earliest due date
2024-02-29
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 |
|---|---|---|---|---|
| O20050214000541 | O | Clinic/Group Practice | KS | 2024-02-29 |
| O20180618000880 | O | Physician - Anesthesiology | KS | 2026-10-31 |
| O20190201001480 | O | Clinic/Group Practice | MO | 2024-03-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 66048)
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