Shawn C Vredenburg, PA
Individual provider Active NPI Physician Assistant · Wichita, KS
NPI 1194079277 · NPPES record last updated Jul 18, 2025
Key facts
- NPI
- 1194079277
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- T03473 (KS)
- Practice address
- 3311 E Murdock St
Wichita, KS 67208-3054 - Phone
- (316) 689-9107
- NPI assigned
- Oct 29, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Decatur Health Systems Inc
Practice addresses (Care Compare)
810 W Columbia St
Oberlin, KS 67749-2450
Phone (785) 475-2208
Hospital & facility affiliations
- Decatur Health
- Hutchinson Regional Medical Center Inc
- Kingman Healthcare Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130225000213 | KS | Practitioner - Physician Assistant | 7517112568 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4822 | OK | MD | Durable Medical Equipment & Medical Supplies |
| T03473 | KS | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hutchinson Regional Medical Center, Inc. | Current |
Accepting new patients | |
| Ninnescah Valley Health Systems, Inc. | Current | Accepting new patients | |
| Hutchinson Regional Medical Center, Inc. | Current |
Accepting new patients | |
| Ninnescah Valley Health Systems, Inc. | Current |
Accepting new patients | |
| Decatur Health Systems Inc | Current |
Accepting new patients | |
| Ninnescah Valley Health Systems, Inc. | Past | Accepting new patients | |
| Cancer Center of Kansas, P.a. | Past | Accepting new patients | |
| Goodland Regional Medical Center | Past | Accepting new patients |
Locations
1701 E 23rd Ave
Hutchinson, KS 67502
Phone (620) 665-2117
750 W D Ave
Kingman, KS 67068
Phone (620) 532-0295
902 W Columbia St
Oberlin, KS 67749
Phone (785) 475-2221
810 W Columbia St
Oberlin, KS 67749
Phone (785) 475-2200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | T03473 | KS | Yes |
Addresses
Primary practice location
3311 E Murdock St
Wichita, KS 67208-3054
Mailing address
1121 S Dodge Ave
Wichita, KS 67213-4436
Phone (316) 617-8546
NPI Registry JSON
{
"created_epoch": "1351468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752796800000",
"number": "1194079277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1121 S DODGE AVE",
"city": "WICHITA",
"state": "KS",
"postal_code": "672134436",
"telephone_number": "316-617-8546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3311 E MURDOCK ST",
"city": "WICHITA",
"state": "KS",
"postal_code": "672083054",
"telephone_number": "316-689-9107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VREDENBURG",
"first_name": "SHAWN",
"middle_name": "C",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-10-29",
"last_updated": "2025-07-18",
"certification_date": "2025-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "KS",
"license": "T03473",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
- Jennifer Voth
- Matthew T Voth
- Riki D Voth
- Devin Jeanne Vrana
- Crystal Vrbas
- Vu Medical Clinic, P.a.
- Banglinh Nguyen Vu
- Christine Tran Vu
- Francis P Vu
- Kelly Vu
All providers in Wichita, KS · Physician Assistant in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.