Active NPI
Rick Pustka, P.A.
- Surgical Physician Assistant
- Wichita, KS
National Provider Identifier
1124088703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 1500950
- Practice address
- 2610 N Woodlawn Blvd
Wichita, KS 67220-2729 - Phone
- (316) 858-2601
- Fax
- (316) 858-2793
- NPI assigned
- Mar 27, 2006
- Last updated
- Apr 28, 2010
- 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 | 1500950 | KS | Primary |
Addresses
Primary practice location
2610 N Woodlawn Blvd
Wichita, KS 67220-2729
Mailing address
2610 N Woodlawn Blvd
Wichita, KS 67220-2729
Phone (316) 858-2601
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200260850A | Medicaid | KS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1500950 | KS | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scotland County Memorial Hospital | Past | Accepting new patients | |
| Mid America Surgical Associates | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Surgery Physician
- Wichita, KS
- NPI 1710948906
-
dba Lancaster Medical Services
- Rural Health Clinic/Center
- Lancaster, MO
- NPI 1407865132
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272412800000",
"number": "1124088703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2610 N WOODLAWN BLVD",
"city": "WICHITA",
"state": "KS",
"postal_code": "672202729",
"telephone_number": "316-858-2601",
"fax_number": "316-858-2793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2610 N WOODLAWN BLVD",
"city": "WICHITA",
"state": "KS",
"postal_code": "672202729",
"telephone_number": "316-858-2601",
"fax_number": "316-858-2793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUSTKA",
"first_name": "RICK",
"name_prefix": "Mr.",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-27",
"last_updated": "2010-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "KS",
"license": "1500950",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200260850A",
"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 Apr 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.