Kansas Pediatric Neurology Center LLC

Primary specialty

Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X

Legal business name

KANSAS PEDIATRIC NEUROLOGY CENTER LLC

Practice address

10111 E 21St St N Ste 405
Wichita, KS 67206-3508

Phone

(316) 796-5610

Fax

(316) 796-5611

NPI assigned

May 24, 2019

Organization subpart

No

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

Authorized official

Name

Bassem El-Nabbout, MD

Title

Direct Owner

Phone

(316) 253-8090

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19607/brand/1/csg/1/fhir/r4

Practitioners 2

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

• Carly Anne Knoblauch

  • Family Nurse Practitioner
  • Wichita, KS
  • NPI 1457953135
  NPD
• Tessa Kae Eftekhar, NP

  • Family Nurse Practitioner
  • Wichita, KS
  • NPI 1770271173
  NPD (past)

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

{
    "created_epoch": "1558656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558656000000",
    "number": "1184281131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10111 E 21ST ST N STE 405",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063508",
            "telephone_number": "316-796-5610",
            "fax_number": "316-796-5611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10111 E 21ST ST N STE 405",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063508",
            "telephone_number": "316-796-5610",
            "fax_number": "316-796-5611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANSAS PEDIATRIC NEUROLOGY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-24",
        "last_updated": "2019-05-24",
        "status": "A",
        "authorized_official_last_name": "EL-NABBOUT",
        "authorized_official_first_name": "BASSEM",
        "authorized_official_title_or_position": "DIRECT OWNER",
        "authorized_official_telephone_number": "316-253-8090",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Wichita, KS
• Neurology with Special Qualifications in Child Neurology Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.