Active NPI
Alexander P Rusanowsky Jr.
- Surgery Physician
- Wichita, KS
National Provider Identifier
1407893910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 1200341
- Practice address
- 5500 E Kellogg Dr
Wichita, KS 67218-1607 - Phone
- (316) 685-2221
- NPI assigned
- Jun 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 589 | CO | |
| Surgery Physician | 208600000X | 1200341 | KS | Primary |
Addresses
Primary practice location
5500 E Kellogg Dr
Wichita, KS 67218-1607
Mailing address
5500 E Kellogg Dr
Wichita, KS 67218-1607
Phone (316) 685-2221
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1200341 | KS | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222646400000",
"number": "1407893910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5500 E KELLOGG DR",
"city": "WICHITA",
"state": "KS",
"postal_code": "672181607",
"telephone_number": "316-685-2221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5500 E KELLOGG DR",
"city": "WICHITA",
"state": "KS",
"postal_code": "672181607",
"telephone_number": "316-685-2221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSANOWSKY",
"first_name": "ALEXANDER",
"middle_name": "P",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-01",
"last_updated": "2008-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CO",
"license": "589",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "KS",
"license": "1200341",
"primary": true
}
],
"identifiers": [],
"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 Sep 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.