Organization Active NPI

Blue Sky Primary Care PA

  • Family Medicine Physician
  • Wichita, KS
National Provider Identifier
1124852066
Registry record updated Nov 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BLUE SKY PRIMARY CARE PA
Practice address
925 N Hillside St
Wichita, KS 67214-3219
Phone
(316) 689-4203
Fax
(316) 235-2460
NPI assigned
Aug 30, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2025

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

Authorized official

Name
Kari Edwards
Title
General Manager
Phone
(316) 616-3333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

925 N Hillside St
Wichita, KS 67214-3219

Mailing address

925 N Hillside St
Wichita, KS 67214-3219
Phone (316) 689-4203

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS, OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20241114003543 KS Part B Supplier - Clinic/Group Practice 9830623735 Receives reassigned benefits from 3 practitioners
Practice locations: Wichita, KS
O20250212003255 OK Part B Supplier - Clinic/Group Practice 9830623735 Receives reassigned benefits from 1 practitioner
Practice locations: Weatherford, OK

National Provider Directory

National Provider Directory

Locations

111 S Whittier Rd
Ste 330
Wichita, KS 67207
Phone (316) 293-0285

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1724976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763078400000",
    "number": "1124852066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 N HILLSIDE ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672143219",
            "telephone_number": "316-689-4203",
            "fax_number": "316-235-2496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 N HILLSIDE ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672143219",
            "telephone_number": "316-689-4203",
            "fax_number": "316-235-2460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE SKY PRIMARY CARE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-30",
        "last_updated": "2025-11-14",
        "certification_date": "2025-11-14",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "KARI",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "316-616-3333"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Nov 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.