NPIMap

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

Organization Active NPI Pain Medicine (Anesthesiology) Physician · Wichita, KS

NPI 1033628243 · NPPES record last updated May 27, 2025

Key facts

NPI
1033628243
Entity type
Organization (NPI type 2)
Primary specialty
Pain Medicine (Anesthesiology) Physician 207LP2900X
Legal business name
KANSAS SPINE & SPECIALTY HOSPITAL, L.L.C.
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
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 3

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

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 1

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

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 101

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

View all 101

Medicare Care Compare: Hospital

Listed as
Kansas Spine & Specialty Hospital, LLC CCN 170196
Type
Acute Care Hospitals
Ownership
Physician
Medicare certification status
Active (Provider of Services file)
Emergency services
No

Source: Medicare Care Compare.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D2161899Kansas Spine & Specialty Hospital Pain Center
3223 N Webb Rd Suite 3, Wichita, KS 67226		Certificate of waiverFeb 12, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in KS

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
LLC · Proprietary
Enrollment address
3333 N Webb Rd
Wichita, KS 67226-8123
Main/Primary Hospital Location
Hospital subgroups
Acute care, Specialty hospital

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 Officer
Officer 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 Interest
MD		 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 Interest
MD		 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 Employee
Hospital Cfo		 Aug 13, 2018
Harrison R Bane
Individual 		Other
Nat'L GRP Pres & Cho Administrator		 Sep 1, 2024
Chandra Tokala
Individual 		5% Or Greater Indirect Ownership Interest
MD		 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 Officer
Hospital Ceo		 Apr 14, 2025
W-2 Managing Employee
Hospital Ceo		 Apr 14, 2025

Medicare enrollment records

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

National Provider Directory

Locations

3333 N Webb Rd
Ste 3
Wichita, KS 67226

3223 N Webb Rd
Ste 3
Wichita, KS 67226
Phone (316) 462-5072

Interoperability endpoints

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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207LP2900X Yes

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

IdentifierTypeStateIssuer
200257840AMedicaidKS

Other names

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

Other providers in Wichita, KS

All providers in Wichita, KS · Pain Medicine (Anesthesiology) Physician in Kansas

Sources for this page

Verify at the official NPI Registry.