Provider Demographics
NPI:1821148123
Name:CROSS, SARA ELIZABETH
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:CROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ELIZABETH
Other - Last Name:TIRRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9100 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-4004
Mailing Address - Country:US
Mailing Address - Phone:913-676-2214
Mailing Address - Fax:
Practice Address - Street 1:9100 W 74TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-4004
Practice Address - Country:US
Practice Address - Phone:913-676-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005016345207P00000X
MO2008014373207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1821148123Medicaid
KS200616950AMedicaid
KSP00738054OtherRR MEDICARE GROUP CG8899
KS42646016OtherBCBS KC GROUP 30492021
KS2000616950BMedicaid
KS42646026OtherBCBS KC GROUP 01674018
KSP00738054OtherRR MEDICARE GROUP CG8899
MO1821148123Medicaid
KS42646026OtherBCBS KC GROUP 01674018
IL$$$$$$$$$-1Medicaid
MO150050009Medicare PIN
MO1821148123Medicaid
MO147400008Medicare PIN