MEDICARE: SUMMER ELYSE BAUMSTARK PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	2025034236	MO
2	363AM0700X	Medical Physician Assistant	7744	AZ

General Provider Information

NPI Number	:	1407408537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMMER ELYSE BAUMSTARK PA

Provider Business Mailing Address
First Line	:	3130 MERSINGTON AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64128-1755
Country	:	US
Telephone Number	:	816-404-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 MERSINGTON AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64128-1755
Country	:	US
Telephone Number	:	816-404-6700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	10/15/2025

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