NPIMap

Organization Active NPI

Family Medcenters, P.a.

  • Family Medicine Physician
  • Derby, KS
National Provider Identifier
1285688358
Registry record updated Oct 25, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAMILY MEDCENTERS, P.A.
Practice address
1101 N Rock Rd
Derby, KS 67037-3735
Phone
(316) 788-6963
Fax
(316) 788-5373
NPI assigned
May 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2007

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

Authorized official

Name
David W. Niederee, M.D.
Title
President
Phone
(316) 788-6963

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1101 N Rock Rd
Derby, KS 67037-3735

Mailing address

1101 N Rock Rd
Derby, KS 67037-3735
Phone (316) 788-6963

Other identifiers 2

IdentifierTypeStateIssuer
110501OtherKSBC/BS
CG1679OtherKSMEDICARE RAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040210000627 KS Part B Supplier - Clinic/Group Practice 4688568751 Receives reassigned benefits from 18 practitioners
Practice locations: Derby, KS

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1101 N Rock Rd
Derby, KS 67037
Phone (316) 788-6669

7150 E Harry St
Wichita, KS 67207
Phone (316) 687-2651

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1148169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193270400000",
    "number": "1285688358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 N ROCK RD",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670373735",
            "telephone_number": "316-788-6963",
            "fax_number": "316-788-5373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 N ROCK RD",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670373735",
            "telephone_number": "316-788-6963",
            "fax_number": "316-788-5373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDCENTERS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-21",
        "last_updated": "2007-10-25",
        "status": "A",
        "authorized_official_last_name": "NIEDEREE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "316-788-6963",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "110501",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CG1679",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Derby, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.