Individual provider Active NPI

Evan Crenshaw

  • Physical Therapist
  • Wellington, KS
National Provider Identifier
1134810351
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11-07351 Issued in KS
Practice address
513 E 16TH St
Wellington, KS 67152-2802
Phone
(620) 968-3134
NPI assigned
May 18, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 11-07351 KS Primary

Addresses

Primary practice location

513 E 16TH St
Wellington, KS 67152-2802

Mailing address

200 W Douglas Ave Ste 250
Wichita, KS 67202-3002
Phone (316) 263-0003

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230615000258 KS Practitioner - Physical Therapist in Private Practice 7416315916 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced PT LLCGroup PAC ID 3678524709, 84 clinicians

Practice addresses (Care Compare)

513 E 16TH St
Advanced PT Wellington
Wellington, KS 67152-2802
Phone (620) 968-3134

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced PT LLC Physical Therapist CurrentSince Jun 7, 2023 Accepting new patients
Advanced PT LLC Physical Therapist CurrentSince Jun 7, 2023 Accepting new patients

Locations

550 N Andover Rd
Andover, KS 67002
Phone (316) 202-0195

513 E 16th St
Wellington, KS 67152
Phone (620) 968-3134

3730 N Ridge Rd
Ste 500
Wichita, KS 67205
Phone (316) 440-4901

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1684368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1134810351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W DOUGLAS AVE STE 250",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672023002",
            "telephone_number": "316-263-0003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 E 16TH ST",
            "city": "WELLINGTON",
            "state": "KS",
            "postal_code": "671522802",
            "telephone_number": "620-968-3134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRENSHAW",
        "first_name": "EVAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-18",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-07351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellington, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.