Luis Felipe Camacho
Individual provider Active NPI Family Nurse Practitioner · Liberal, KS
NPI 1104418458 · NPPES record last updated Oct 2, 2024
Key facts
- NPI
- 1104418458
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 82969 (KS)
- Practice address
- 305 W 15TH St Ste 102
Liberal, KS 67901-2455 - Phone
- (620) 417-7578
- Fax
- (680) 417-7577
- NPI assigned
- Feb 8, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southwest Medical Center
Practice addresses (Care Compare)
555 W 15TH St
15TH Street Family Care Center
Liberal, KS 67901-2467
Phone (620) 624-0702
Hospital & facility affiliations
- Health Watch Health Care of Liberal, LLC
- Elara Caring
- Southwest Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- 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 |
|---|---|---|---|---|
| I20240320002926 | KS | Practitioner - Nurse Practitioner | 1759728116 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 82969 | KS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwest Medical Center | Current |
Accepting new patients | |
| Southwest Medical Center | Current |
Accepting new patients | |
| Southwest Medical Center | Past | Accepting new patients |
Locations
2130 N Kansas Ave
Liberal, KS 67901
Phone (316) 626-5060
555 W 15th St
Liberal, KS 67901
Phone (620) 624-0702
305 W 15th St
Ste 102
Liberal, KS 67901
Phone (620) 417-7577
315 W 15th St
Liberal, KS 67901
Phone (620) 624-1651
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JGBGAA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 82969 | KS | Yes |
Addresses
Primary practice location
305 W 15TH St Ste 102
Liberal, KS 67901-2455
Mailing address
315 W 15TH St
Liberal, KS 67901-2455
Phone (620) 624-1651
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 82969 | Other | KS | KANSAS STATE LICENSE |
Other providers in Liberal, KS
- Bishal Bista
- Lauren Taylor Boyce
- Cara A Boyd
- Dustin Elizabeth Burke
- Carmelita D Caedo
- Cancer Center of Kansas, P.a.
- Carmelita Caedo MD Radiology PA
- Theresa Carrillo
- Linsey Kay Carter
- Central Care, PA
All providers in Liberal, KS · Family 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 Oct 2, 2024. 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.