Individual provider Active NPI

Karen E Wilson, P.T.

  • Physical Therapist
  • Wichita, KS
National Provider Identifier
1376574665
Registry record updated Mar 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11-03155 Issued in KS
Practice address
3730 N Ridge Rd
Ste 500
Wichita, KS 67205-1227
Phone
(316) 440-4901
Fax
(316) 440-4904
NPI assigned
Jul 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 11-03155 KS Primary

Addresses

Primary practice location

3730 N Ridge Rd
Ste 500
Wichita, KS 67205-1227

Mailing address

200 W Douglas
Ste 1040
Wichita, KS 67202-3017
Phone (316) 263-0003

Other identifiers 1

IdentifierTypeStateIssuer
200307090AMedicaidKS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040924000706 KS Practitioner - Physical Therapist in Private Practice 7810966009 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
University of Kansas School of Med (KC/Wich/Sal), 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced PT LLCGroup PAC ID 3678524709, 84 clinicians

Practice addresses (Care Compare)

3460 N Ridge Rd
80 Advanced PT Aquatic Rehab
Wichita, KS 67205-1223
Phone (316) 202-0340

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11-03155KSMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced PT LLC Physical Therapist CurrentSince Sep 8, 2009 Accepting new patients
Advanced PT LLC Physical Therapist CurrentSince Sep 8, 2009 Accepting new patients
Preferred PT LLC Physical Therapist PastSince Jul 1, 2021 Accepting new patients

Locations

3730 N Ridge Rd
Ste 500
Wichita, KS 67205
Phone (316) 440-4901

200 W Douglas Ave
Ste 1040
Wichita, KS 67202
Phone (866) 412-5554

3460 N Ridge Rd
Ste 80
Wichita, KS 67205
Phone (316) 202-0340

6940 W Newell St
Wichita, KS 67212
Phone (316) 440-3731

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362441600000",
    "number": "1376574665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W DOUGLAS",
            "address_2": "STE 1040",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672023017",
            "telephone_number": "316-263-0003",
            "fax_number": "316-263-1241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3730 N RIDGE RD",
            "address_2": "STE 500",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672051227",
            "telephone_number": "316-440-4901",
            "fax_number": "316-440-4904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KAREN",
        "middle_name": "E",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2013-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-03155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200307090A",
            "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 Mar 5, 2013; 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.