NPIMap

Organization Active NPI

Stonecreek Family Physicians, LLP

  • Family Medicine Physician
  • Manhattan, KS
National Provider Identifier
1093828097
Registry record updated Sep 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
STONECREEK FAMILY PHYSICIANS, LLP
Practice address
4101 Anderson Ave
Manhattan, KS 66503-7588
Phone
(785) 587-4101
Fax
(785) 587-9090
NPI assigned
Aug 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2021

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

Authorized official

Name
Dr. Kevin K Wall, M.D.NPI 1285673087
Title
Partner
Phone
(785) 587-4101

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X KS Primary

Addresses

Primary practice location

4101 Anderson Ave
Manhattan, KS 66503-7588

Mailing address

4101 Anderson Ave
Manhattan, KS 66503-7588
Phone (785) 587-4101

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040602001030 KS Part B Supplier - Clinic/Group Practice 9335121565 Receives reassigned benefits from 24 practitioners
Practice locations: Manhattan, KS

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D0449905Stonecreek Family Physicians LLP4101 Anderson Avenue, Manhattan, KS 66503AccreditationMay 31, 2028

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CEIABD

Practitioners & affiliated clinicians

Practitioners 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632873600000",
    "number": "1093828097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 ANDERSON AVE",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "665037588",
            "telephone_number": "785-587-4101",
            "fax_number": "785-587-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 ANDERSON AVE",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "665037588",
            "telephone_number": "785-587-4101",
            "fax_number": "785-587-9090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONECREEK FAMILY PHYSICIANS, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "785-587-4101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "KS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manhattan, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; 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.