Basic Information
| Provider Information | |||||||||
| NPI: | 1336251891 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEARA | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | BRADLEY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2330 SHAWNEE MISSION PKWY | ||||||||
| Address2: | MEDICAL ADMINISTRATIVE SERVICES OF KU MED. STE 312 | ||||||||
| City: | WESTWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662052005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135889000 | ||||||||
| FaxNumber: | 9135889822 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 RAINBOW BLVD | ||||||||
| Address2: | PROFESSIONAL SERVICES OF KU HOSPITAL | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135886504 | ||||||||
| FaxNumber: | 9135889104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 06/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2009033375 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 04-27094 | KS | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100366390C | 05 | KS | MEDICAID | 10001758001 | 01 | CHP PSKU | OTHER | 080175970 | 01 | RR MEDICARE | OTHER | 481202402 | 01 | PSKU TAX ID | OTHER | 202299129 | 05 | MO | MEDICAID | 26732025 | 01 | BCBS PROVIDER NUMBER | OTHER | 658471 | 01 | FIRSTGUARD | OTHER | 7166132 | 01 | AETNA | OTHER |