NPIMap

Individual provider Active NPI

Michelle J Stahly, PA-C

  • Physician Assistant
  • Wichita, KS
National Provider Identifier
1104833300
Registry record updated Aug 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
15-01791 Issued in KS
Practice address
3311 E Murdock St
Wichita, KS 67208-3054
Phone
(316) 689-9107
Fax
(316) 689-9354
NPI assigned
Aug 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 15-01791 KS Primary
Physician Assistant 363A00000X 1239 NE

Addresses

Primary practice location

3311 E Murdock St
Wichita, KS 67208-3054

Mailing address

PO Box 8035
Wichita, KS 67208-0035
Phone (316) 689-9135

Other identifiers 3

IdentifierTypeStateIssuer
283821AOtherRURL HEALTH
1826OtherNESTATE LICENSE
P00338774OtherMEDICARE RAILROAD

Other names 1

  • Michelle J Gibbons Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150827002870 KS Practitioner - Physician Assistant 0749283364 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Susan B Allen Memorial HospitalGroup PAC ID 7719898980, 26 clinicians

Practice addresses (Care Compare)

720 W Central Ave
El Dorado, KS 67042-2112

Hospital & facility affiliations

  • Susan B Allen Memorial Hospital Hospital, El Dorado, KS, CCN 170017

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1239NEMDOptometrist
15-01791KSMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - Kansas LLC CurrentSince Jan 1, 2017 Accepting new patients
Susan B. Allen Memorial Hospital CurrentSince Jun 1, 2024 Accepting new patients
Susan B. Allen Memorial Hospital CurrentSince Jun 1, 2024 Accepting new patients
Cep America - Kansas LLC CurrentSince Jan 1, 2017 Accepting new patients
Carepoint Hospital Medicine Kansas LLC PastSince Jun 27, 2021 Accepting new patients
Hanger Inpatient Services, LLC Past Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

720 W Central Ave
El Dorado, KS 67042
Phone (316) 321-3000

Organizations & group practices 10

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 1

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": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439164800000",
    "number": "1104833300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8035",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672080035",
            "telephone_number": "316-689-9135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3311 E MURDOCK ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672083054",
            "telephone_number": "316-689-9107",
            "fax_number": "316-689-9354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAHLY",
        "first_name": "MICHELLE",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2015-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-01791",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "1239",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RURL HEALTH",
            "identifier": "283821A",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "1826",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00338774",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "GIBBONS",
            "middle_name": "J",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.