Individual provider Active NPI

Benjamin Scott Kallenberger, DO

  • Anesthesiology Physician
  • Wichita, KS
National Provider Identifier
1457765133
Registry record updated Feb 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
6682 Issued in OK
Practice address
1010 N Kansas St
Wichita, KS 67214-3124
Phone
(316) 293-2665
NPI assigned
Jun 20, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 4, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 9408339 KS
Anesthesiology Physician 207L00000X 6682 OK Primary

Addresses

Primary practice location

1010 N Kansas St
Wichita, KS 67214-3124

Mailing address

3130 E 26TH PL
Tulsa, OK 74114-4314
Phone (918) 906-9110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190802002291 OK Practitioner - Anesthesiology 3173740560 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergenchealth PLLCGroup PAC ID 1355606641, 1,037 clinicians

Practice addresses (Care Compare)

1120 S Utica Ave
HC Med Ctr
Tulsa, OK 74104-4012
Phone (918) 579-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
6682OKMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Emergenchealth PLLC Anesthesiology CurrentSince Feb 1, 2021 Accepting new patients

Locations

10512 N 110th East Ave
Owasso, OK 74055
Phone (918) 272-1172

1120 S Utica Ave
Tulsa, OK 74104
Phone (918) 579-6090

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1403222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1457765133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3130 E 26TH PL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741144314",
            "telephone_number": "918-906-9110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 N KANSAS ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672143124",
            "telephone_number": "316-293-2665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLENBERGER",
        "first_name": "BENJAMIN",
        "middle_name": "SCOTT",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-20",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "KS",
            "license": "9408339",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OK",
            "license": "6682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.