Wichita Nephrology Group, PA

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

04-35548 Issued in KS

Legal business name

WICHITA NEPHROLOGY GROUP, PA

Doing business as

ReVask Surgery Center LLC

Practice address

2122 N Garnett St
Wichita, KS 67206-3023

Phone

(316) 636-1234

Fax

(316) 636-2630

NPI assigned

Jun 7, 2018

Last updated

Mar 29, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

WICHITA NEPHROLOGY GROUP, PAAs reported in NPPES

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

Authorized official

Name

Wissam Saliba, MDNPI 1104025949

Title

Director

Phone

(316) 263-5891

Specialties & licenses 1

Addresses

Other names 1

• ReVask Surgery Center LLC Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in KS2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Wichita Nephrology Group, PA

  • Nephrology Physician
  • Wichita, KS
  • NPI 1104877810

  3375596174

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Wichita Nephrology Group, PA

  • Nephrology Physician
  • Wichita, KS
  • NPI 1104877810

  O20050221000714

  Same enrollment

Listed as

Wichita Nephrology Group Dba Revask Surgery CenterCCN 17C0001100

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Wichita Nephrology Group

Locations

Interoperability endpoints

• Direct secure messaging: michelle@wngpa.com

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Wichita Nephrology Group, PA

  • Nephrology Physician
  • Wichita, KS
  • NPI 1104877810
  NPPES parent name

Practitioners 13

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.

• Wissam Saliba, MD

  • Internal Medicine Physician
  • Wichita, KS
  • NPI 1104025949
  Medicare reassignment NPD Authorized official
• Michael Edward Grant, M.D.

  • Nephrology Physician
  • Wichita, KS
  • NPI 1316990781
  Medicare reassignment NPD
• Joseph Meouchy, MD

  • Nephrology Physician
  • Wichita, KS
  • NPI 1922396894
  Medicare reassignment NPD
• Jany Khairallah Moussa, M.D.

  • Nephrology Physician
  • Wichita, KS
  • NPI 1861443459
  Medicare reassignment NPD
• Ronnie K Moussa, MD

  • Internal Medicine Physician
  • Wichita, KS
  • NPI 1437316387
  Medicare reassignment NPD
• Mohamad S Sandid, M.D.

  • Nephrology Physician
  • Wichita, KS
  • NPI 1992778518
  Medicare reassignment NPD
• Levi Curtis Short, MD

  • Nephrology Physician
  • Wichita, KS
  • NPI 1790198448
  Medicare reassignment NPD
• Amanda M Valliant, MD

  • Nephrology Physician
  • Wichita, KS
  • NPI 1609004316
  Medicare reassignment NPD
• Edgard Ibrahim Wehbe, MD

  • Nephrology Physician
  • Wichita, KS
  • NPI 1851513287
  Medicare reassignment NPD
• Erica L Roach, APRN

  • Adult Health Nurse Practitioner
  • Wichita, KS
  • NPI 1386282655
  NPD
• Tracy D Smith, APRN

  • Family Nurse Practitioner
  • Wichita, KS
  • NPI 1053727800
  NPD
• Freidy Eid, MD

  • Cardiovascular Disease Physician
  • Wichita, KS
  • NPI 1629205356
  NPD (past)

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

{
    "created_epoch": "1528329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1396238010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 N GARNETT ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063023",
            "telephone_number": "316-263-5891",
            "fax_number": "316-263-3083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2122 N GARNETT ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063023",
            "telephone_number": "316-636-1234",
            "fax_number": "316-636-2630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICHITA NEPHROLOGY GROUP, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WICHITA NEPHROLOGY GROUP, PA",
        "enumeration_date": "2018-06-07",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A",
        "authorized_official_last_name": "SALIBA",
        "authorized_official_first_name": "WISSAM",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "316-263-5891",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "KS",
            "license": "04-35548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "michelle@wngpa.com",
            "affiliation": "N",
            "address_1": "2122 N Garnett St",
            "city": "Wichita",
            "state": "KS",
            "country_code": "US",
            "postal_code": "672063023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "ReVask Surgery Center LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wichita KS Homecare (Visiting Angels)
• Wichita Medical Associates, PA
• Wichita Medical Investors, LLC (Life Care Center of Wichita)
• Wichita Mind & Wellness LLC
• Wichita Nephrology Group, PA
• Wichita OB-GYN Associates, PA
• Wichita Occupational Rehab & Solutions PA
• Wichita Ocd Center Inc
• Wichita Operations Assoc LLC (Wichita Center for Rehabilitation and Healthcare)
• Wichita Operator, LLC

• Ambulatory Surgical Clinic/Center in Wichita, KS
• Providers in Wichita, KS by specialty
• Ambulatory Surgical Clinic/Center in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; 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.