Provider Demographics
NPI:1992798094
Name:HODOS, REBECCA SUE (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SUE
Last Name:HODOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:SUE
Other - Last Name:URBAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9411 N OAK TRFY STE LL1
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2262
Mailing Address - Country:US
Mailing Address - Phone:816-691-1655
Mailing Address - Fax:816-455-5294
Practice Address - Street 1:2700 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 240
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3251
Practice Address - Country:US
Practice Address - Phone:816-455-0681
Practice Address - Fax:816-455-5294
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30362207R00000X
MO118565208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100643980AMedicaid
MO1992798094Medicaid
KS100643980BMedicaid
MO205879802Medicaid
7445001OtherAETNA
370510OtherFIRST GUARD
25932022OtherBCBS
370510OtherFIRST GUARD
KS100643980BMedicaid