Provider Demographics
NPI:1982712543
Name:GAYNES, STUART MARK (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:MARK
Last Name:GAYNES
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66201-0716
Mailing Address - Country:US
Mailing Address - Phone:913-642-4900
Mailing Address - Fax:913-381-0979
Practice Address - Street 1:20333 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5350
Practice Address - Country:US
Practice Address - Phone:913-791-4357
Practice Address - Fax:913-791-4435
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC52009207P00000X
KS0426382207PE0005X
KS04-26382207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100289450CMedicaid
MO1982712543Medicaid
KS930110421OtherRR MEDICARE
KS23896031OtherBCBSKC
KS5165400OtherAETNA
KSP00812184OtherRR MEDICARE-WHA
KS100289450BMedicaid
KS100289450BMedicaid
KSKA1657002Medicare PIN
KSK549845Medicare PIN