Bethelem Wondimu Bedasso
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Shawnee, KS
NPI 1073397642 · NPPES record last updated Aug 23, 2023
Key facts
- NPI
- 1073397642
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 53-82444-092 (KS)
- Practice address
- 7450 Quivira Rd
Shawnee, KS 66216-3526 - Phone
- (913) 706-2508
- NPI assigned
- Aug 23, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Med Management of Kansas LLC
Mokscare Family Medicine
Practice addresses (Care Compare)
1220 E 8TH St
Galena, KS 66739-1865
Phone (888) 365-6271
22550 S Franklin St
Spring Hill, KS 66083-8763
Phone (888) 365-6271
520 E Morse Ave
Bonner Springs, KS 66012-1911
Phone (888) 365-6271
600 NW Pryor Rd
Lees Summit, MO 64081-1104
Phone (888) 365-6271
7721 Quivira Rd
Lenexa, KS 66216-3401
Phone (913) 706-2508
9100 Park St
Lenexa, KS 66215-3353
Phone (888) 365-6271
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KS, MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240316000199 | KS | Practitioner - Nurse Practitioner | 0941646624 | Reassigns benefits to 2 organizations |
| I20240404003580 | MO | Practitioner - Nurse Practitioner | 0941646624 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53-82444-092 | KS | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mokscare Family Medicine | Psychiatric/Mental Health | Current |
Accepting new patients |
| Med Management of Kansas LLC | Current |
Accepting new patients |
Locations
520 E Morse Ave
Bonner Springs, KS 66012
Phone (913) 441-2515
7721 Quivira Rd
Shawnee, KS 66216
Phone (913) 248-2838
7450 Quivira Rd
Shawnee Mission, KS 66216
Phone (913) 248-8880
600 NW Pryor Rd
Lees Summit, MO 64081
Phone (816) 251-8000
7272 Wurzbach Rd
Ste 601
San Antonio, TX 78240
Phone (210) 615-3472
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 53-82444-092 | KS | Yes |
Addresses
Primary practice location
7450 Quivira Rd
Shawnee, KS 66216-3526
Mailing address
7450 Quivira Rd
Shawnee, KS 66216-3526
Phone (913) 706-2508
Other providers in Shawnee, KS
- Tanner Beam
- Ashley Bean
- Andrea M. Beatty
- Eric Scott Beatty
- Melanie M Beck
- Jennifer Beech
- Ruth A Beezhold
- Michael J. Beezley
- Behavioral Services of Johnson County, LLC
- Natasha Collette Belcher
All providers in Shawnee, KS · Psychiatric/Mental Health Nurse Practitioner in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.