Basic Information
| Provider Information | |||||||||
| NPI: | 1073622148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASEY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 SW 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666041301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853546241 | ||||||||
| FaxNumber: | 7852704343 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 SW 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666041301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853546241 | ||||||||
| FaxNumber: | 7852704343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 02/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 04-17200 | KS | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0205X | 04-17200 | KS | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 370017514 | 01 | RR MEDICARE | OTHER | 100085610B | 05 | KS | MEDICAID | 205142201 | 05 | MO | MEDICAID | 27320011 | 01 | MO | BCBS KANSAS CITY | OTHER | 100085610C | 05 | KS | MEDICAID | 068002097 | 01 | KS | MEDICARE PTAN | OTHER | 610461 | 01 | KS | FIRSTGUARD | OTHER |