Jerad E Widman, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

04-30763 Issued in KS

Practice address

22450 S Harrison St
Ste. 100
Spring Hill, KS 66083-3151

Phone

(913) 592-2720

Fax

(913) 592-2725

NPI assigned

Jun 9, 2006

Last updated

Oct 23, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO, KS2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Family Practice

Education

University of Kansas School of Med (KC/Wich/Sal), 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Memorial Hospital DistrictGroup PAC ID 0345153680, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ellett Memorial Hospital Hospital, Appleton City, MO, CCN 261301
• Ellett Memorial Hospital Nursing home, CCN 26Z301

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Practitioners 2

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.

• Tory Christopher Fisher, PA-C

  • Medical Physician Assistant
  • Spring Hill, KS
  • NPI 1740790500
  Medicare reassignment
• Samantha Marie Schroeder, PA-C

  • Physician Assistant
  • Spring Hill, KS
  • NPI 1538472550
  Medicare reassignment

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.

• Community Memorial Hospital District

  dba AC Rural Health Clinic

  • Family Medicine Physician
  • Appleton City, MO
  • NPI 1619117256
  Medicare reassignment Care Compare group NPD
• Lincoln County Hospital

  dba Lincoln Medical Clinic

  • Rural Health Clinic/Center
  • Lincoln, KS
  • NPI 1841248952
  Medicare reassignment NPD
• Lincoln County Hospital

  • Critical Access Hospital
  • Lincoln, KS
  • NPI 1942265327
  Medicare reassignment NPD
• Shawnee Mission Medical Center Inc

  dba AdventHealth Medical Group

  • Family Medicine Physician
  • Merriam, KS
  • NPI 1992735690
  Medicare reassignment NPD
• Spring Hill Family Medicine Express

  • Urgent Care Clinic/Center
  • Spring Hill, KS
  • NPI 1932538535
  NPD (past) Authorized official
• Community Memorial Hospital District

  dba Ellett Memorial Hospital

  • Critical Access Hospital
  • Appleton City, MO
  • NPI 1609894716
  NPD (past)
• Community Memorial Hospital District

  dba AC Rural Health Clinic

  • Rural Health Clinic/Center
  • Appleton City, MO
  • NPI 1861559817
  NPD (past)
• Harrison County Community Hospital District

  dba Harrison County Community Hospital

  • Critical Access Hospital
  • Bethany, MO
  • NPI 1528062569
  NPD (past)

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

• Community Memorial Hospital District

  dba Ellett Memorial Hospital

  • Critical Access Hospital
  • Appleton City, MO
  • NPI 1609894716
  Care Compare affiliation
• Community Memorial Hospital District

  dba Ellett Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Appleton City, MO
  • NPI 1992730261

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571788800000",
    "number": "1083655039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22450 S HARRISON ST",
            "address_2": "STE 100",
            "city": "SPRING HILL",
            "state": "KS",
            "postal_code": "660833151",
            "telephone_number": "913-592-2720",
            "fax_number": "913-592-2725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22450 S HARRISON ST",
            "address_2": "STE. 100",
            "city": "SPRING HILL",
            "state": "KS",
            "postal_code": "660833151",
            "telephone_number": "913-592-2720",
            "fax_number": "913-592-2725"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "705 N College St",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "MO",
            "postal_code": "644021433",
            "country_code": "US",
            "telephone_number": "660-726-3941",
            "fax_number": "660-726-3946",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIDMAN",
        "first_name": "JERAD",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2019-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-30763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200300220D",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Spring Hill, KS
• Providers in Spring Hill, KS by specialty
• Family Medicine Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; 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.
• 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.