NPIMap

Organization Active NPI

Primary Care Associates, LLC

  • Family Medicine Physician
  • Wichita, KS
National Provider Identifier
1003832403
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PRIMARY CARE ASSOCIATES, LLC
Practice address
7111 E 21St St N Ste a
Wichita, KS 67206-1078
Phone
(316) 684-2851
NPI assigned
Jul 15, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jed D Holmes, M.D.NPI 1033111331
Title
Medical Director
Phone
(316) 684-2851

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

7111 E 21St St N Ste a
Wichita, KS 67206-1078

Mailing address

7111 E 21St St N Ste a
Wichita, KS 67206-1078
Phone (316) 684-2851

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040226000340 KS Part B Supplier - Clinic/Group Practice 1153235015 Receives reassigned benefits from 18 practitioners
Practice locations: Wichita, KS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D1044765Primary Care Associates7111 E 21St St N, Ste a, Wichita, KS 67206AccreditationJul 12, 2026

National Provider Directory

National Provider Directory

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Locations

122 N Park Ave
#R
Valley Center, KS 67147
Phone (316) 755-1511

7111 E 21st St N
Ste A
Wichita, KS 67206
Phone (316) 684-2851

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003832403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7111 E 21ST ST N STE A",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672061078",
            "telephone_number": "316-684-2851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7111 E 21ST ST N STE A",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672061078",
            "telephone_number": "316-684-2851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "JED",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "316-684-2851",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.