Kansas Masonic Home

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

N087008 Issued in KS

Legal business name

KANSAS MASONIC HOME

Doing business as

Kansas Masonic Home

Practice address

401 S Seneca St
Wichita, KS 67213-5541

Phone

(316) 269-7652

Fax

(316) 269-7643

NPI assigned

Oct 4, 2006

Last updated

Jul 10, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Matthew Bogner

Title

C.E.O.

Phone

(316) 269-7650

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kansas Masonic Home Doing business as

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436486400000",
    "number": "1437244654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S SENECA ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672135541",
            "telephone_number": "316-269-7652",
            "fax_number": "316-269-7643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 S SENECA ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672135541",
            "telephone_number": "316-269-7652",
            "fax_number": "316-269-7643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANSAS MASONIC HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2015-07-10",
        "status": "A",
        "authorized_official_last_name": "BOGNER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "316-269-7650",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "KS",
            "license": "N087008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0578",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100107460A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kansas Masonic Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Wichita, KS
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.