NPIMap

Individual provider Active NPI

Mark Ethan Vannorden, D.O.

  • Family Medicine Physician
  • Larned, KS
National Provider Identifier
1376595959
Registry record updated Apr 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
05-30418 Issued in KS
Practice address
200 E 8TH St
Larned, KS 67550-2602
Phone
(620) 285-6041
Fax
(620) 285-6194
NPI assigned
May 16, 2006
Last updated
Apr 1, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 1, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 0530418 KS
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 05-30418 KS
Family Medicine Physician 207Q00000X 05-30418 KS Primary

Addresses

Primary practice location

200 E 8TH St
Larned, KS 67550-2602

Mailing address

200 E 8TH St
Larned, KS 67550-2602
Phone (620) 285-6041

Other practice location 1

3515 Broadway Ave
Great Bend, KS 67530-3633
Phone (620) 793-8429

Other identifiers 3

IdentifierTypeStateIssuer
107025OtherKSBLUE SHIELD
200252510CMedicaidKS
200252510FMedicaidKS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040514000871 KS Practitioner - Emergency MedicinePractitioner - Family Practice 8729078456 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Midwestern University, Chicago College of Osteopathic Med, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ukhs Great Bend LLCGroup PAC ID 5597016378, 64 clinicians

Practice addresses (Care Compare)

200 E 8TH St
Larned, KS 67550-2602
Phone (620) 285-6041

3515 Broadway Ave
Great Bend, KS 67530-3633
Phone (620) 786-6515

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
0530418KSMDEmergency Medicine Physician
05-30418KSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
A Healthy Choice Clinic CurrentSince Feb 1, 2008 Accepting new patients
Ukhs Great Bend, LLC Emergency Medicine CurrentSince Mar 4, 2019 Accepting new patients
The Clara Barton Hospital Association Inc Hoisington Kansas Past Accepting new patients
Diversicare of Larned LLC Past Accepting new patients
St. Joseph Memorial Hospital, Inc. Family Medicine Past Accepting new patients
Central Kansas Medical Center Family Medicine Past Accepting new patients
St. Joseph Memorial Hospital, Inc. Past Accepting new patients

Locations

3515 Broadway Ave
Great Bend, KS 67530
Phone (620) 786-6163

514 Cleveland St
Great Bend, KS 67530
Phone (620) 659-2890

250 W 9th St
Hoisington, KS 67544
Phone (620) 653-2114

200 E 8th St
Larned, KS 67550
Phone (620) 285-6041

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14974/brand/1/csg/1/fhir/r4
  • Direct secure messaging: mark.vannorden.1@14974.direct.athenahealth.com
  • Direct secure messaging: mark.vannorden@khindirect.org
  • Direct secure messaging: mvannorden636980@direct.kuha.org

Organizations & group practices 7

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

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585699200000",
    "number": "1376595959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E 8TH ST",
            "city": "LARNED",
            "state": "KS",
            "postal_code": "675502602",
            "telephone_number": "620-285-6041",
            "fax_number": "620-285-6194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E 8TH ST",
            "city": "LARNED",
            "state": "KS",
            "postal_code": "675502602",
            "telephone_number": "620-285-6041",
            "fax_number": "620-285-6194"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3515 Broadway Ave",
            "address_purpose": "LOCATION",
            "city": "Great Bend",
            "state": "KS",
            "postal_code": "675303633",
            "country_code": "US",
            "telephone_number": "620-793-8429",
            "fax_number": "620-793-6014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANNORDEN",
        "first_name": "MARK",
        "middle_name": "ETHAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2020-04-01",
        "certification_date": "2020-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KS",
            "license": "0530418",
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "KS",
            "license": "05-30418",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "05-30418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "107025",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200252510C",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200252510F",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Larned, KS

Sources for this page

Verify at the official NPI Registry.