Active NPI
Wade Matherly, P.A.
- Physician Assistant
- Sedan, KS
National Provider Identifier
1043629413
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 300 W North St
Sedan, KS 67361-1051 - Phone
- (620) 725-3115
- NPI assigned
- Aug 10, 2014
- Last updated
- Apr 24, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | KS | Primary |
Addresses
Primary practice location
300 W North St
Sedan, KS 67361-1051
Mailing address
1705 E 19TH St
Ste 302
Tulsa, OK 74104-5410
Phone (918) 645-3612
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2554 | OK | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sedan City Hospital | Current | Accepting new patients | |
| Sedan City Hospital | Current | Accepting new patients | |
| James M McDermott DO | Past | Accepting new patients | |
| James M. McDermott D.O. | Past | Accepting new patients |
Locations
300 W North St
Sedan, KS 67361
Phone (620) 725-3115
Organizations & group practices 5
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Critical Access Hospital
- Sedan, KS
- NPI 1033114277
-
- Family Medicine Physician
- Cedar Vale, KS
- NPI 1427079953
-
- Emergency Medicine Physician
- Sedan, KS
- NPI 1710058466
-
- Family Medicine Physician
- Cedar Vale, KS
- NPI 1437276995
-
- Family Medicine Physician
- Cedar Vale, KS
- NPI 1942540810
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587686400000",
"number": "1043629413",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1705 E 19TH ST",
"address_2": "STE 302",
"city": "TULSA",
"state": "OK",
"postal_code": "741045410",
"telephone_number": "918-645-3612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W NORTH ST",
"city": "SEDAN",
"state": "KS",
"postal_code": "673611051",
"telephone_number": "620-725-3115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHERLY",
"first_name": "WADE",
"credential": "P.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-08-10",
"last_updated": "2020-04-24",
"certification_date": "2020-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "KS",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sedan, KS
- H&G&K Phcy Inc (Sedan Pharmacy)
- Derrick W. Kimball, D.C.
- Kisa Life Recovery, LLC
- Bethany Anne Lear, RD, LD
- Levi Lear, PA-C
- Pharmacy Innovations LLC (Creative Health Pharmacy of Sedan)
- Pleasant Valley Nursing, LLC (Pleasant Valley Manor)
- Lori Ann Ridder, PA
- Elizabeth Catherine Ross
- Sedan Area Emergency Medical Service District 2 Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.