NPIMap

Individual provider Active NPI

Cory Andrew Ciccone, D.O.

  • Internal Medicine Physician
  • Wichita, KS
National Provider Identifier
1154617793
Registry record updated Oct 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
05-40186 Issued in KS
Practice address
1131 S Clifton Ave Ste B
Wichita, KS 67218-2963
Phone
(316) 462-1040
Fax
(316) 462-1042
NPI assigned
Jun 22, 2011
Last updated
Oct 11, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 05-40186 KS Primary

Addresses

Primary practice location

1131 S Clifton Ave Ste B
Wichita, KS 67218-2963

Mailing address

12101 Woodcrest Executive Dr Ste 210
Saint Louis, MO 63141-5047
Phone (314) 317-0600

Other identifiers 1

IdentifierTypeStateIssuer
10025533600MedicaidNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220721002307 OK Practitioner - Internal Medicine 3476780420 Reassigns benefits to 3 organizations
I20251121000743 NC Practitioner - Internal Medicine 3476780420 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3201 Rushmore St
Bartlesville, OK 74006-6373
Phone (800) 424-3672

509 Biltmore Ave
Asheville, NC 28801-4601
Phone (828) 213-1111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
1082NEMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Medical Group, PC CurrentSince Oct 1, 2025 Accepting new patients
Usacs Observation Medicine Services of Oklahoma, LLC CurrentSince Oct 29, 2024 Accepting new patients
Hospital Physician Services - Southeast Professional Corporation CurrentSince Oct 1, 2025 Accepting new patients
Kansas Inpatient Services, LLC Past Accepting new patients
Jane Phillips Memorial Medical Center, Inc. Past Accepting new patients
Kansas Long Term Care Physicians, LLC PastSince Feb 11, 2013 Accepting new patients

Locations

509 Biltmore Ave
Asheville, NC 28801
Phone (828) 213-2325

260 Hospital Dr
Brevard, NC 28712
Phone (828) 883-5286

124 One Center Ct
Franklin, NC 28734
Phone (828) 369-4214

288 S Ridgecrest Ave
Rutherfordton, NC 28139
Phone (252) 808-6000

3500 E Frank Phillips Blvd
Bartlesville, OK 74006
Phone (918) 331-1555

300 Rockefeller Dr
Muskogee, OK 74401
Phone (918) 682-5501

6161 S Yale Ave
Tulsa, OK 74136
Phone (918) 494-2200

Organizations & group practices 7

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.

Hospital & facility affiliations 8

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": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507680000000",
    "number": "1154617793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12101 WOODCREST EXECUTIVE DR STE 210",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415047",
            "telephone_number": "314-317-0600",
            "fax_number": "314-317-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1131 S CLIFTON AVE STE B",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672182963",
            "telephone_number": "316-462-1040",
            "fax_number": "316-462-1042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CICCONE",
        "first_name": "CORY",
        "middle_name": "ANDREW",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-22",
        "last_updated": "2017-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "05-40186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025533600",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.