Provider Demographics
NPI:1730246992
Name:EARNEST, MATTHEW BRYAN (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRYAN
Last Name:EARNEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9119 W 74TH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2268
Mailing Address - Country:US
Mailing Address - Phone:913-632-9400
Mailing Address - Fax:913-632-9444
Practice Address - Street 1:9119 W 74TH ST STE 350
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2268
Practice Address - Country:US
Practice Address - Phone:913-632-9400
Practice Address - Fax:913-632-9444
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007010291207RC0000X, 207RI0011X
KS04-31399207RC0000X, 207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1730246992Medicaid
MO41386011OtherBC BS KC
KS200572210AMedicaid
MO41386011OtherBC BS KC
MO038E00006Medicare UPIN
KS110330011Medicare PIN
KSP00698385Medicare PIN
MO1730246992Medicaid
KS038B00001Medicare PIN