NPIMap

Wichita Nephrology Group, PA

Organization Active NPI Ambulatory Surgical Clinic/Center · Wichita, KS

NPI 1396238010 · NPPES record last updated Mar 29, 2021

Key facts

NPI
1396238010
Entity type
Organization (NPI type 2)
Primary specialty
Ambulatory Surgical Clinic/Center 261QA1903X
License
04-35548 (KS)
Legal business name
WICHITA NEPHROLOGY GROUP, PA
Practice address
2122 N Garnett St
Wichita, KS 67206-3023
Phone
(316) 636-1234
Fax
(316) 636-2630
NPI assigned
Jun 7, 2018
Organization subpart
Yes
Parent organization (as reported)
WICHITA NEPHROLOGY GROUP, PA

Authorized official

Name
Wissam Saliba, MD
Title
Director
Phone
(316) 263-5891

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.

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 1

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

Practitioners 14

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

Medicare Care Compare: Ambulatory surgical center

Listed as
Wichita Nephrology Group Dba Revask Surgery Center CCN 17C0001100
Medicare certification status
Active (Provider of Services file)

Source: Medicare Care Compare.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D2160355Revask Surgery Center, LLC
2122 N Garnett Street, Wichita, KS 67206		Certificate of waiverJan 8, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in KS

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20050221000714 KS Part B Supplier - Clinic/Group Practice 3375596174 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wichita, KS; Hutchinson, KS; Winfield, KS; Garden City, KS; Coffeyville, KS; Derby, KS; Dodge City, KS; Eldorado, KS…
O20200220000836 KS Part B Supplier - Ambulatory Surgical Center 3375596174 Receives reassigned benefits from 9 practitioners
Practice locations: Wichita, KS

National Provider Directory

Part of
Wichita Nephrology Group

Locations

701 W Central Ave
El Dorado, KS 67042
Phone (316) 321-1368

401 N Main St
Garden City, KS 67846
Phone (620) 276-0994

3904 6th St
Great Bend, KS 67530
Phone (620) 792-2944

10001 W Grady Ave
Maize, KS 67101
Phone (316) 773-1400

203 Watson St
Ste 110
Pratt, KS 67124
Phone (620) 672-7006

2630 N Webb Rd
Ste 200
Wichita, KS 67226
Phone (316) 636-1234

5500 E Kellogg Dr
#J
Wichita, KS 67218
Phone (316) 651-3633

1551 N Rock Rd
Wichita, KS 67206
Phone (316) 634-0094

818 N Emporia St
#S310
Wichita, KS 67214

929 N Saint Francis Ave
Rm 5009
Wichita, KS 67214
Phone (318) 268-5593

2122 N Garnett St
Wichita, KS 67206
Phone (316) 636-1234

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 04-35548 KS Yes

Addresses

Primary practice location

2122 N Garnett St
Wichita, KS 67206-3023

Mailing address

2122 N Garnett St
Wichita, KS 67206-3023
Phone (316) 263-5891

Other names

  • ReVask Surgery Center LLC Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
Direct Messaging Address michelle@wngpa.com

Other providers in Wichita, KS

All providers in Wichita, KS · Ambulatory Surgical Clinic/Center in Kansas

Sources for this page

Verify at the official NPI Registry.