NPIMap

Organization Active NPI

Wichita Urology Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Wichita, KS
National Provider Identifier
1245806876
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
WICHITA UROLOGY SURGERY CENTER LLC
Practice address
2620 N Webb Rd
Wichita, KS 67226-8110
Phone
(316) 636-6176
NPI assigned
Jun 3, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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

Authorized official

Name
Jennifer L Ale-Ebrahim, MHA
Title
Executive Director
Phone
(316) 636-6110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

2620 N Webb Rd
Wichita, KS 67226-8110

Mailing address

2620 N Webb Rd
Wichita, KS 67226-8110
Phone (316) 358-0813

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210803001785 KS Part B Supplier - Ambulatory Surgical Center 5597169219 Practice locations: Wichita, KS

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Wichita Urology Surgery Center LLCCCN 17C0001896
Medicare certification status
ActiveFrom the Provider of Services file

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
17D2232077Wichita Urology Surgery Center2620 N Webb Rd, Wichita, KS 67226Certificate of waiverAug 9, 2027

National Provider Directory

National Provider Directory

Locations

2620 N Webb Rd
Wichita, KS 67226
Phone (316) 358-0813

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1622678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731456000000",
    "number": "1245806876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 N WEBB RD",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672268110",
            "telephone_number": "316-358-0813",
            "fax_number": "316-358-0314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 N WEBB RD",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672268110",
            "telephone_number": "316-636-6176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICHITA UROLOGY SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-03",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A",
        "authorized_official_last_name": "ALE-EBRAHIM",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "316-636-6110",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "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 Nov 13, 2024; 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.