NPIMap

Organization Active NPI

Mid-Kansas Wound Specialist P a

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Wichita, KS
National Provider Identifier
1326076977
Registry record updated Oct 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianTaxonomy code 2083P0011X
Legal business name
MID-KANSAS WOUND SPECIALIST P A
Practice address
10346 E Stonegate LN Ste 100
Wichita, KS 67206-2054
Phone
(316) 910-0024
Fax
(316) 910-0023
NPI assigned
Jun 30, 2006
Last updated
Oct 19, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2023

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

Authorized official

Name
Justin GoodenNPI 1205127982
Title
Owner
Phone
(972) 786-4990

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician 2083P0011X NU Primary

Addresses

Primary practice location

10346 E Stonegate LN Ste 100
Wichita, KS 67206-2054

Mailing address

PO Box 801660
Kansas City, MO 64180-0001
Phone (800) 700-0278

Other practice location 1

550 N Hillside St
Wichita, KS 67214-4910
Phone (316) 862-2239

Other identifiers 2

IdentifierTypeStateIssuer
110380OtherKSBLUE CROSS GROUP #
CI6093OtherKSRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040510000974 KS Part B Supplier - Clinic/Group Practice 3678562147 Receives reassigned benefits from 20 practitioners
Practice locations: Hutchinson, KS; Wichita, KS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697673600000",
    "number": "1326076977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 801660",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641800001",
            "telephone_number": "800-700-0278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10346 E STONEGATE LN STE 100",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672062054",
            "telephone_number": "316-910-0024",
            "fax_number": "316-910-0023"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "550 N Hillside St",
            "address_purpose": "LOCATION",
            "city": "Wichita",
            "state": "KS",
            "postal_code": "672144910",
            "country_code": "US",
            "telephone_number": "316-862-2239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MID-KANSAS WOUND SPECIALIST P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A",
        "authorized_official_last_name": "GOODEN",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-786-4990"
    },
    "taxonomies": [
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP #",
            "identifier": "110380",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CI6093",
            "state": "KS"
        }
    ],
    "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 Oct 19, 2023; 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.