Active NPI
Jerrod A. Conkling, P.A.
- Surgical Physician Assistant
- Wichita, KS
National Provider Identifier
1114950706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 15-01039
- Practice address
- 3223 N Webb Rd
Suite 1
Wichita, KS 67226-8175 - Phone
- (316) 609-2600
- Fax
- (316) 609-2800
- NPI assigned
- Jul 8, 2006
- Last updated
- Jan 21, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 15-01039 | KS | Primary |
Addresses
Primary practice location
3223 N Webb Rd
Suite 1
Wichita, KS 67226-8175
Mailing address
3223 N Webb Rd
Suite 1
Wichita, KS 67226-8175
Phone (316) 609-2600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2003475208B | Medicaid | KS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
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
Practice addresses (Care Compare)
8110 E 32ND St N
Suite 125
Wichita, KS 67226-2644
Phone (316) 330-3636
Hospital & facility affiliations
- NMC Health
- SCK Health
- Ascension Via Christi Hospitals Wichita, Inc.
- Pratt Regional Medical Center
- Susan B Allen Memorial Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.98 of 100
- Quality
- 96.61
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 73.33
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15-01039 | KS | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid-Kansas Women's Center P.a. | Past | Accepting new patients | |
| University of Kansas School of Medicine Wichita Medical Practice Assoc | Past | Accepting new patients |
Interoperability endpoints
- jerrod.conkling.1@17686.direct.athenahealth.com
Organizations & group practices 3
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.
-
- Endocrinology, Diabetes & Metabolism Physician
- Wichita, KS
- NPI 1770080673
-
- Obstetrics & Gynecology Physician
- Wichita, KS
- NPI 1568456945
-
- Internal Medicine Physician
- Wichita, KS
- NPI 1639143712
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Wichita, KS
- NPI 1154314789
-
dba Pratt Regional Medical Center
- Rural Acute Care Hospital
- Pratt, KS
- NPI 1578596904
-
dba South Central Kansas Medical Center
- Rural Acute Care Hospital
- Arkansas City, KS
- NPI 1609842681
-
- General Acute Care Hospital
- El Dorado, KS
- NPI 1700994977
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421798400000",
"number": "1114950706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3223 N WEBB RD",
"address_2": "SUITE 1",
"city": "WICHITA",
"state": "KS",
"postal_code": "672268175",
"telephone_number": "316-609-2600",
"fax_number": "316-609-2800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3223 N WEBB RD",
"address_2": "SUITE 1",
"city": "WICHITA",
"state": "KS",
"postal_code": "672268175",
"telephone_number": "316-609-2600",
"fax_number": "316-609-2800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONKLING",
"first_name": "JERROD",
"middle_name": "A.",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-08",
"last_updated": "2015-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "KS",
"license": "15-01039",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2003475208B",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; 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.