Al Mamon Abu Ghanimah, MD
Individual provider Active NPI Hospitalist Physician · Topeka, KS
NPI 1417239013 · NPPES record last updated Dec 4, 2025
Key facts
- NPI
- 1417239013
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Hospitalist Physician 208M00000X
- License
- 04-37184 (KS)
- Practice address
- 1500 SW 10TH Ave
Topeka, KS 66604-1301 - Phone
- (785) 354-5242
- NPI assigned
- Sep 9, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Hospitalist
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cotton-O'Neil Clinic Revocable Trust
Practice addresses (Care Compare)
1500 SW 10TH Ave
Stormont Vail Hospital
Topeka, KS 66604-1301
Phone (785) 354-6000
Hospital & facility affiliations
- Stormont Vail Hospital
- Ascension Via Christi Hospital Manhattan, Inc
- Coffey County Hospital
- University of Kansas Health System - St Francis Campus
- Nemaha Valley Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140827001104 | KS | Practitioner - Hospitalist |
5395963714 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-37184 | KS | MD | Hospitalist Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cotton-O'Neil Clinic Revocable Trust | Current |
Accepting new patients | |
| Cotton-O'Neil Clinic Revocable Trust | Current |
Accepting new patients | |
| Stormont Vail Health Flint Hills LLC | Hospitalist | Current |
Accepting new patients |
| Stormont Vail Health Flint Hills LLC | Current |
Accepting new patients | |
| Stormont-Vail Healthcare Inc | Past | Accepting new patients |
Locations
1110 Saint Marys Rd
Junction City, KS 66441
Phone (785) 238-4131
1102 Saint Marys Rd
Junction City, KS 66441
Phone (785) 238-0325
901 SW Garfield Ave
Topeka, KS 66606
1500 SW 10th Ave
Topeka, KS 66604
Phone (785) 354-5242
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | 04-37184 | KS | Yes |
Addresses
Primary practice location
1500 SW 10TH Ave
Topeka, KS 66604-1301
Mailing address
1500 SW 10TH Ave
Topeka, KS 66604-1301
Phone (785) 354-5242
Other practice location 1
1102 Saint Marys Rd
Junction City, KS 66441-4139
Phone (785) 238-0325
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30004272600001 | Medicaid | KS | |
| 201100090A | Medicaid | KS | |
| 068002266 | Other | KS | MEDICARE PTAN |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | aabughanimah25363@stormontvaildirect.org | Direct | COTTON O'NEIL CLINIC REVOCABLE TRUST |
| Direct Messaging Address | aabughanimah25363@stormontvaildirect.org | Direct | STORMONT-VAIL HEALTHCARE INC |
Other providers in Topeka, KS
- Hossam Saher Ahmad Abed
- Angela Jean Abel
- Above and Beyond ABA KS LLC
- Caroline C Abrahamson
- Bahaa Abu Bakr
- Omar Abdelaziz Abu Naba'a
- Natasha Abu-Ali
- Hanin Abu-Hijleh
- Khalil M Abuamr
- Abundant Life Counseling
All providers in Topeka, KS · Hospitalist Physician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.