DR. MARY ANN LILLIG, D.O. - NPI NUMBER 1902899834

Summary

Provider Name: DR. MARY ANN LILLIG, D.O.

NPI Number: 1902899834

Clasification: Internal Medicine (207R00000X)

Address:
6675 HOLMES RD
STE 400
KANSAS CITY, MO
ZIP 64131

Phone Number: (816) 276-7410



Detailed Information

DR. Mary Ann Lillig, D.O. is an internist in Kansas City, MO. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. The assigned NPI number for this provider is 1902899834 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

6675 HOLMES RD
STE 400
KANSAS CITY, MO
ZIP 64131-150
Phone: (816) 276-7410
Fax: (816) 276-7816

The enumeration date for this NPI number is 8/25/2005 and was last updated on 1/21/2015.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207R00000X Internal Medicine 05-28496 KS No
2 207R00000X Internal Medicine 1999135661 MO Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 1902899834 MEDICAID MO
2 P01000002 MEDICARE PIN MO
3 26231025 OTHER MO BLUE SHIELD KC, MO
4 G92147 MEDICARE UPIN
5 100351420B MEDICAID KS
6 204776215 MEDICAID MO
7 P00792361 MEDICARE PIN MO
8 P00345672 OTHER KS RAILROAD MEDICARE
9 W18A208 MEDICARE PIN KS

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1902899834 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name LILLIG The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name MARY ANN The first name of the provider, if the provider is an individual.
5 Provider Name Prefix Text DR. The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
6 Provider Credential Text D.O. The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
7 Provider Other Last Name DRINKHOUSE Other last name by which the provider being identified is or has been known.
8 Provider Other First Name MARY ANN Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider first name’’ if the provider is or has been known by a different last name only.
9 Provider Other Last Name Type Code 5 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
10 Provider First Line Business Practice Location Address 6675 HOLMES RD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
11 Provider Second Line Business Practice Location Address STE 400 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
12 Provider Business Practice Location Address City Name KANSAS CITY The city name in the location address of the provider being identified.
13 Provider Business Practice Location Address State Name MO The State code in the location of the provider being identified.
14 Provider Business Practice Location Address Postal Code 641311150 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
15 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
16 Provider Business Practice Location Address Telephone Number 8162767410 The telephone number associated with the location address of the provider being identified.
17 Provider Business Practice Location Address Fax Number 8162767816 The fax number associated with the location address of the provider being identified.
18 Provider Enumeration Date 8/25/2005 The date the provider was assigned a unique identifier (assigned an NPI).
19 Last Update Date 1/21/2015 The date that a record was last updated or changed.
20 Provider Gender Code F The code designating the provider’s gender if the provider is a person.
21 Healthcare Provider Taxonomy Code 1 207R00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
22 Provider License Number 1 05-28496 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
23 Provider License Number State Code 1 KS The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
24 Healthcare Provider Primary Taxonomy Switch 1 N
25 Healthcare Provider Taxonomy Code 2 207R00000X
26 Provider License Number 2 1999135661 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
27 Provider License Number State Code 2 MO The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
28 Healthcare Provider Primary Taxonomy Switch 2 Y
29 Other Provider Identifier 1 1902899834 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
30 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
31 Other Provider Identifier State 1 MO
32 Other Provider Identifier 2 P01000002 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
33 Other Provider Identifier Type Code 2 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
34 Other Provider Identifier State 2 MO
35 Other Provider Identifier 3 26231025 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
36 Other Provider Identifier Type Code 3 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
37 Other Provider Identifier State 3 MO
38 Other Provider Identifier Issuer 3 BLUE SHIELD KC, MO
39 Other Provider Identifier 4 G92147 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
40 Other Provider Identifier Type Code 4 02 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
41 Other Provider Identifier 5 100351420B Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
42 Other Provider Identifier Type Code 5 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
43 Other Provider Identifier State 5 KS
44 Other Provider Identifier 6 204776215 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
45 Other Provider Identifier Type Code 6 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
46 Other Provider Identifier State 6 MO
47 Other Provider Identifier 7 P00792361 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
48 Other Provider Identifier Type Code 7 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
49 Other Provider Identifier State 7 MO
50 Other Provider Identifier 8 P00345672 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
51 Other Provider Identifier Type Code 8 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
52 Other Provider Identifier State 8 KS
53 Other Provider Identifier Issuer 8 RAILROAD MEDICARE
54 Other Provider Identifier 9 W18A208 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
55 Other Provider Identifier Type Code 9 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
56 Other Provider Identifier State 9 KS
57 Is Sole Proprietor N Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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