Individual provider Active NPI

Wade Kyle Moore

  • Certified Registered Nurse Anesthetist
  • Hutchinson, KS
National Provider Identifier
1053107672
Registry record updated May 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
43-558280-122 Issued in KS
Practice address
1701 E 23Rd Ave
Hutchinson, KS 67502-9907
Phone
(620) 524-0799
NPI assigned
Apr 18, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 28, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Certified Registered Nurse Anesthetist 367500000X 43-558280-122 KS Primary

Addresses

Primary practice location

1701 E 23Rd Ave
Hutchinson, KS 67502-9907

Mailing address

5 Monarch LN
Hutchinson, KS 67502-9115
Phone (620) 245-4715

Other practice location 1

2101 N Waldron St Bldg 2205
Hutchinson, KS 67502-1197
Phone (620) 728-2700

Other practice location 2

1818 E 23rd Ave
Hutchinson, KS 67502-1106
Phone (620) 663-4800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250616003319 KS Practitioner - Certified Registered Nurse Anesthetist (Crna) 1759892870 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hutchinson Regional Medical Center Inc 145 clinicians
Summit Surgical Anesthesia LLC 17 clinicians

Practice addresses (Care Compare)

1701 E 23Rd Ave
Hutchinson, KS 67502-1105

1818 E 23Rd Ave
Hutchinson, KS 67502-1106
Phone (620) 662-6000

Hospital & facility affiliations

  • Hutchinson Regional Medical Center Inc Hospital, Hutchinson, KS, CCN 170020
  • Summit Surgical, LLC Hospital, Hutchinson, KS, CCN 170198

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
43-558280-122KSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Surgical Anesthesia LLC Nurse Anesthetist, Certified Registered CurrentSince Jun 6, 2025 Accepting new patients
Hutchinson Regional Medical Center, Inc. Current Accepting new patients
Hutchinson Regional Medical Center, Inc. CurrentSince Jun 15, 2025 Accepting new patients
Hutchinson Regional Medical Center, Inc. Nurse Anesthetist, Certified Registered CurrentSince Jun 15, 2025 Accepting new patients
Hutchinson Ambulatory Surgery Center, LLC Past Accepting new patients

Locations

1701 E 23rd Ave
Hutchinson, KS 67502
Phone (620) 665-2117

2101 N Waldron St
Bldg 2205
Hutchinson, KS 67502
Phone (620) 727-0718

1818 E 23rd Ave
Hutchinson, KS 67502
Phone (620) 662-6000

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1744934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748390400000",
    "number": "1053107672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 MONARCH LN",
            "city": "HUTCHINSON",
            "state": "KS",
            "postal_code": "675029115",
            "telephone_number": "620-245-4715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 E 23RD AVE",
            "city": "HUTCHINSON",
            "state": "KS",
            "postal_code": "675029907",
            "telephone_number": "620-524-0799"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2101 N Waldron St Bldg 2205",
            "address_purpose": "LOCATION",
            "city": "Hutchinson",
            "state": "KS",
            "postal_code": "675021197",
            "country_code": "US",
            "telephone_number": "620-728-2700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1818 E 23rd Ave",
            "address_purpose": "LOCATION",
            "city": "Hutchinson",
            "state": "KS",
            "postal_code": "675021106",
            "country_code": "US",
            "telephone_number": "620-663-4800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "WADE",
        "middle_name": "KYLE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-04-18",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KS",
            "license": "43-558280-122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hutchinson, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2025; 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.