Concierge Medicine of Wichita LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

04-29832 Issued in KS

Legal business name

CONCIERGE MEDICINE OF WICHITA LLC

Practice address

9449 E 21St St N
Ste. 200
Wichita, KS 67206-2969

Phone

(316) 462-1070

Fax

(316) 462-1078

NPI assigned

Oct 2, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Aly A Gadalla, MDNPI 1083693634

Title

Owner

Phone

(316) 462-1070

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Locations

Practitioners 1

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

• Aly A Gadalla, MD

  • Internal Medicine Physician
  • Wichita, KS
  • NPI 1083693634
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1349136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352419200000",
    "number": "1326399205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9449 E 21ST ST N",
            "address_2": "STE. 200",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672062969",
            "telephone_number": "316-462-1070",
            "fax_number": "316-462-1078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9449 E 21ST ST N",
            "address_2": "STE. 200",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672062969",
            "telephone_number": "316-462-1070",
            "fax_number": "316-462-1078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCIERGE MEDICINE OF WICHITA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-02",
        "last_updated": "2012-11-09",
        "status": "A",
        "authorized_official_last_name": "GADALLA",
        "authorized_official_first_name": "ALY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "316-462-1070",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "04-29832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Wichita, KS
• Providers in Wichita, KS by specialty
• Internal Medicine Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2012; 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.