Individual provider Active NPI

Michael A Clouse, P.A.

  • Medical Physician Assistant
  • Wichita, KS
National Provider Identifier
1326129743
Registry record updated Mar 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1501038 Issued in KS
Practice address
4722 W Kellogg Dr
Wichita, KS 67209-2508
Phone
(316) 440-2565
Fax
(316) 440-2750
NPI assigned
Oct 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 1501038 KS Primary

Addresses

Primary practice location

4722 W Kellogg Dr
Wichita, KS 67209-2508

Mailing address

4722 W Kellogg Dr
Wichita, KS 67209-2508
Phone (316) 440-2565

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050915000166 KS Practitioner - Physician Assistant 6305879800 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wichita Surgical Specialists PAGroup PAC ID 6507840634, 60 clinicians
Emergent Care Plus of Overland Park LLCGroup PAC ID 8123153939, 26 clinicians

Practice addresses (Care Compare)

10090 E Shannon Woods Cir
Wichita, KS 67226-4107
Phone (316) 684-2838

1100 N 4TH St
Leavenworth, KS 66048-1572
Phone (913) 297-9945

1261 N Maize Rd
Wichita, KS 67212-4302
Phone (316) 773-2733

2001 N Rock Rd
Derby, KS 67037-3795
Phone (316) 788-1437

3006 S Seneca St
Wichita, KS 67217-3210
Phone (316) 522-4635

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1501038KSMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Emergent Care Plus, LLC Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427414400000",
    "number": "1326129743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4722 W KELLOGG DR",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672092508",
            "telephone_number": "316-440-2565",
            "fax_number": "316-440-2750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4722 W KELLOGG DR",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672092508",
            "telephone_number": "316-440-2565",
            "fax_number": "316-440-2750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLOUSE",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2015-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KS",
            "license": "1501038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.