Basic Information
| Provider Information | |||||||||
| NPI: | 1053364265 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOCKSTAD | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 CAMBRIDGE ST STE G600 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661608501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135889600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4000 CAMBRIDGE STREET | ||||||||
| Address2: | SUITE G600 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661608501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135889600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 12/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 110276 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RI0011X | 0426647 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 038A00017 | 01 | MO | MEDICARE | OTHER | 038E00028 | 01 | MO | MEDICARE | OTHER | 110330031 | 01 | KS | MEDICARE | OTHER | 431092652 A018 | 01 | CHAMPUS TRICARE | OTHER | 0005658218 | 01 | AETNA PPO | OTHER | 1053364265 | 05 | MO | MEDICAID | 201111290A | 05 | KS | MEDICAID | 0005658218 | 01 | AETNA | OTHER | 038B00037 | 01 | KS | MEDICARE | OTHER | 23450018 | 01 | BLUE SHIELD OF KC HMO | OTHER | 0005658218 | 01 | AETNA HMO | OTHER | 060036604 | 01 | MEDICARE RAILROAD | OTHER | 23450018 | 01 | PHP FREEDOM | OTHER | 23450018 | 01 | BLUE SHIELD OF KC PPO | OTHER | P00853600 | 01 | MO | MEDICARE RAILROAD | OTHER |