Interventional Pain Management Specialist – Pain Medicine Physician, NPI 1740528637
Pain Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Interventional Pain Management Specialist
5701 W. 119TH ST STE 102
OVERLAND PARK, KS 66209
Phone: (913) 498-6124
Fax: (913) 498-6117
Type: Location
7611 STATE LINE RD STE 130
KANSAS, MO 64114
Phone: (816) 255-2788
Fax: (816) 216-6858
Type: Mailing
5401 COLLEGE BLVD STE 111
LEAWOOD, KS 662111626
Phone: (913) 242-7570
Fax: (913) 242-7572
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: 2021-06-21
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-03-31 (800 days ago).
Enrollment records
3
Earliest due date
2024-03-31
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 |
|---|---|---|---|---|
| O20130513000321 | O | Clinic/Group Practice | MO | 2024-03-31 |
| O20130517000558 | O | Clinic/Group Practice | KS | 2025-10-31 |
| O20210621001950 | O | Physician - General Practice | KS | 2024-06-30 |
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 66209)
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