NPIMap

Organization Active NPI

Wichita Primary Care LLC

  • Family Medicine Physician
  • Wichita, KS
National Provider Identifier
1164908281
Registry record updated Jan 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WICHITA PRIMARY CARE LLC
Practice address
2230 N Ridge Rd
Wichita, KS 67205-1053
Phone
(316) 448-8339
Fax
(316) 221-7149
NPI assigned
Jul 11, 2018
Last updated
Jan 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2021

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

Authorized official

Name
Heidi Larison, MDNPI 1447455662
Title
Owner
Phone
(316) 448-8339

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary
Adult Mental Health Clinic/Center 261QM0850X
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

2230 N Ridge Rd
Wichita, KS 67205-1053

Mailing address

2230 N Ridge Rd
Wichita, KS 67205-1053
Phone (316) 448-8339

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190104002967 KS Part B Supplier - Clinic/Group Practice 7911243316 Receives reassigned benefits from 14 practitioners
Practice locations: Wichita, KS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D2165531Wichita Primary Care2230 N Ridge Road, Wichita, KS 67205Certificate of waiverApr 29, 2027

National Provider Directory

National Provider Directory

Locations

2230 N Ridge Rd
Wichita, KS 67205
Phone (316) 448-8339

7348 W 21st St N
Ste 121
Wichita, KS 67205
Phone (316) 722-0103

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1531267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611532800000",
    "number": "1164908281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2230 N RIDGE RD",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672051053",
            "telephone_number": "316-448-8339",
            "fax_number": "316-221-7149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 N RIDGE RD",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672051053",
            "telephone_number": "316-448-8339",
            "fax_number": "316-221-7149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICHITA PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-11",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A",
        "authorized_official_last_name": "LARISON",
        "authorized_official_first_name": "HEIDI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "316-448-8339",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 Jan 25, 2021; 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.