Oswaldo Cruz Bacani Sr., M.D.
Individual provider Active NPI Family Medicine Physician · Fredonia, KS
NPI 1467565879 · NPPES record last updated Oct 7, 2009
Key facts
- NPI
- 1467565879
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 04-17538 (KS)
- Practice address
- 1525 Madison St Ste 3
Fredonia, KS 66736-1704 - Phone
- (620) 378-3700
- Fax
- (620) 378-3536
- NPI assigned
- Aug 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
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 |
|---|---|---|---|---|
| I20050323001118 | KS | Practitioner - General Practice |
3779539655 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-17538 | KS | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jennifer Bacani McKenney, MD, LLC | Family Medicine | Current |
Accepting new patients |
| Fredonia Regional Hospital | Current |
Accepting new patients | |
| Fredonia Regional Hospital | Current |
Accepting new patients |
Locations
1525 Madison St
Ste 3
Fredonia, KS 66736
Phone (620) 378-2061
1527 Madison St
Fredonia, KS 66736
Phone (316) 378-2121
Interoperability endpoints
- oswaldo.cruzbacani@khindirect.org
- https://fhir-myrecord.cerner.com/r4/0153994b-73fd-40ca-acc3-d43bb5781a7b/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 04-17538 | KS | Yes |
| Surgery Physician | 208600000X | 04-17538 | KS |
Addresses
Primary practice location
1525 Madison St Ste 3
Fredonia, KS 66736-1704
Mailing address
PO Box 576
Fredonia, KS 66736-0576
Phone (620) 378-3700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000002897 | Other | KS | BLUE CROSS BLUE SHIELD |
| 100087030-A | Medicaid | KS |
Other providers in Fredonia, KS
- Advanced Healthcare Associates, LLC
- Ambrosio P Mendiola MD LLC
- Koralyn Dawn Barkman
- James E Clay
- Ronald Guy Cleverley
- County of Wilson
- CPF Senior Living - Fredonia LLC
All providers in Fredonia, KS · Family Medicine 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 Oct 7, 2009. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.