Individual provider Active NPI

Le Ann M Petersilie, LSCSW

  • Clinical Social Worker
  • Great Bend, KS
National Provider Identifier
1427668334
Registry record updated Sep 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
06471 Issued in KS
Practice address
1905 19TH St
Great Bend, KS 67530-2502
Phone
(620) 792-5700
NPI assigned
Aug 5, 2020
Last updated
Sep 10, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 06471 KS Primary

Addresses

Primary practice location

1905 19TH St
Great Bend, KS 67530-2502

Mailing address

1905 19TH St
Great Bend, KS 67530-2502
Phone (620) 792-5700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240828004508 KS Practitioner - Clinical Social Worker 4587103015 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Kansas Medical College, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1905 19TH St
Great Bend, KS 67530-2502
Phone (620) 792-5700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11432KSMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Heart of Kansas Family Health Care, Inc. CurrentSince Aug 19, 2024 Accepting new patients
Heart of Kansas Family Health Care, Inc. CurrentSince Aug 19, 2024 Accepting new patients

Locations

1905 19th St
Great Bend, KS 67530
Phone (620) 792-5700

522 Broadway St
Larned, KS 67550
Phone (620) 804-6007

412 Grand Ave
Stafford, KS 67578
Phone (620) 234-2700

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20094/brand/1/csg/1/fhir/r4
  • Direct secure messaging: le.ann.petersilie.1@20094.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1596585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788998400000",
    "number": "1427668334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 19TH ST",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675302502",
            "telephone_number": "620-792-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 19TH ST",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675302502",
            "telephone_number": "620-792-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSILIE",
        "first_name": "LE ANN",
        "middle_name": "M",
        "credential": "LSCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-05",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KS",
            "license": "06471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Bend, KS

Sources for this page

Verify at the official NPI Registry.