NPIMap

Organization Active NPI

Kansas Spine & Specialty Hospital, L.L.C.

Doing business as Kansas Spine & Specialty Hospital Pain Center

  • Pain Medicine (Anesthesiology) Physician
  • Wichita, KS
National Provider Identifier
1033628243
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
KANSAS SPINE & SPECIALTY HOSPITAL, L.L.C.
Doing business as
Kansas Spine & Specialty Hospital Pain Center
Practice address
3223 N Webb Rd Ste 3
Wichita, KS 67226-8176
Phone
(316) 462-5000
Fax
(316) 462-5345
NPI assigned
Sep 20, 2017
Last updated
May 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2025

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

Authorized official

Name
Jennifer Boyd Baldock
Title
Officer and Authorized Official
Phone
(615) 234-5954

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X Primary

Addresses

Primary practice location

3223 N Webb Rd Ste 3
Wichita, KS 67226-8176

Mailing address

3333 N Webb Rd
Wichita, KS 67226-8123
Phone (316) 462-5338

Other identifiers 1

IdentifierTypeStateIssuer
200257840AMedicaidKS

Other names 2

  • Kansas Spine & Specialty Hospital Pain Center Doing business as
  • Kansas Spine & Specialty Pain Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031117000168 KS Part A Provider - Hospital 1456265230 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wichita, KS
O20171110000862 KS Part B Supplier - Clinic/Group Practice 1456265230 Receives reassigned benefits from 10 practitioners
Practice locations: Wichita, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033628243. Details of each certification follow.

Hospital certification: CCN 170196

Legal name
KANSAS SPINE & SPECIALTY HOSPITAL LLC
Doing business as
KANSAS SPINE & SPECIALTY HOSPITAL LLC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Dec 29, 2003
Last certification
Apr 29, 2026
Beds
35
Ownership / control type
Physician ownership
Organization structure
LLCProprietary
Enrollment address
3333 N Webb Rd
Wichita, KS 67226-8123
Main/Primary Hospital Location
Hospital subgroups
Acute care, Specialty hospital

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Kansas Spine & Specialty Hospital, LLCCCN 170196 · All quality measures
Type
Acute Care Hospitals
Ownership
Physician
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

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
17D2161899Kansas Spine & Specialty Hospital Pain Center3223 N Webb Rd Suite 3, Wichita, KS 67226Certificate of waiverFeb 12, 2027

National Provider Directory

National Provider Directory

Locations

3333 N Webb Rd
Ste 3
Wichita, KS 67226

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/kans-0e9f8525

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
SP Holdco I Inc Organization, Brentwood, TN Corporation 5% Or Greater Indirect Ownership Interest Sep 1, 2022 55%
Jennifer B Baldock Individual Corporate OfficerOfficer and Authorized Official Sep 1, 2022
2024 RWG III Irrevocable Trust Organization, Haysville, KS 5% Or Greater Direct Ownership Interest Oct 1, 2024 9.48%
FMR LLC Organization, Boston, MA LLC 5% Or Greater Indirect Ownership Interest Nov 21, 2022 7.26%
John Roger Dickerson Individual 5% Or Greater Indirect Ownership InterestMD Jan 1, 2007 9.74%
SP Management Services Inc Organization, Brentwood, TN Corporation Operational/Managerial Control Sep 1, 2022
Surgery Partners Inc Organization, Brentwood, TN Corporation 5% Or Greater Indirect Ownership Interest Sep 1, 2022 55%
Raymond Grundmeyer Individual 5% Or Greater Indirect Ownership InterestMD Oct 1, 2024 9.48%
2015 Chandra Tokala Irrevocable Trust Organization, Wichita, KS 5% Or Greater Direct Ownership Interest Dec 7, 2015 7.46%
2019 John R Dickerson Irrevocable Trust Organization, Wichita, KS 5% Or Greater Direct Ownership Interest Nov 8, 2019 9.74%
Surgery Center Holdings Inc Organization, Brentwood, TN Corporation 5% Or Greater Direct Ownership Interest Sep 1, 2022 55%
Other Sep 1, 2022 55%
Jennifer L Sanders Individual W-2 Managing EmployeeHospital Cfo Aug 13, 2018
Harrison R Bane Individual OtherNat'L GRP Pres & Cho Administrator Sep 1, 2024
Chandra Tokala Individual 5% Or Greater Indirect Ownership InterestMD Nov 5, 2001 7.46%
Bcpe Seminole Holdings II Intermediate LP Organization, Boston, MA 5% Or Greater Indirect Ownership Interest Mar 31, 2023 13.09%
Surgery Center Holdings LLC Organization, Brentwood, TN LLC 5% Or Greater Indirect Ownership Interest Sep 1, 2022 55%
Cynthia Meaux Individual Corporate OfficerHospital Ceo Apr 14, 2025
W-2 Managing EmployeeHospital Ceo Apr 14, 2025

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 11

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.

Affiliated clinicians 101

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 101

NPI Registry JSON

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

{
    "created_epoch": "1505865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748304000000",
    "number": "1033628243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 N WEBB RD",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672268123",
            "telephone_number": "316-462-5338",
            "fax_number": "316-462-5345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3223 N WEBB RD STE 3",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672268176",
            "telephone_number": "316-462-5000",
            "fax_number": "316-462-5345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANSAS SPINE & SPECIALTY HOSPITAL, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-20",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "BOYD",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5954"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200257840A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kansas Spine & Specialty Hospital Pain Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kansas Spine & Specialty Pain Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Kansas Spine & Specialty Pain Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.