Fort Scott Family Medicine, P.a.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FORT SCOTT FAMILY MEDICINE, P.A.

Practice address

202 State St
Suite a
Fort Scott, KS 66701-2031

Phone

(620) 223-3950

Fax

(620) 223-1302

NPI assigned

Aug 19, 2006

Organization subpart

No

Name

Ricky D Kellenberger, D.O.NPI 1700864568

Title

President

Phone

(620) 223-3950

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ricky Kellenberger, D.O

  • Family Medicine Physician
  • Fort Scott, KS
  • NPI 1700864568

  Family Medicine, KS

  Medicare reassignment Care Compare group NPD Authorized official
• Ryan Lewis

  • Family Nurse Practitioner
  • Fort Scott, KS
  • NPI 1265839690

  KS

  Medicare reassignment Care Compare group NPD
• Randy Kellenberger, D.O.

  • Emergency Medicine Physician
  • Atchison, KS
  • NPI 1932186681

  KS

  Medicare reassignment NPD
• Heather Dawn Burns, DNP, APRN

  • Family Nurse Practitioner
  • Pittsburg, KS
  • NPI 1093337701
  NPD

Medicare fee-for-service enrollment

Enrolled in KS

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467566802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 STATE ST",
            "address_2": "SUITE A",
            "city": "FORT SCOTT",
            "state": "KS",
            "postal_code": "667012031",
            "telephone_number": "620-223-3950",
            "fax_number": "620-223-1302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 STATE ST",
            "address_2": "SUITE A",
            "city": "FORT SCOTT",
            "state": "KS",
            "postal_code": "667012031",
            "telephone_number": "620-223-3950",
            "fax_number": "620-223-1302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT SCOTT FAMILY MEDICINE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KELLENBERGER",
        "authorized_official_first_name": "RICKY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "620-223-3950",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "110645",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2087370801",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly K Ferguson, LMLP
• Mary Jo Flint, M.D.
• Tanner Dean Forrest, ATC
• Fort Scott Chiropractic LLC
• Fort Scott Family Medicine
• Fort Scott Usd 234
• Destiny Denise Foulk, OD
• Foxx Apothecary, Inc
• W. J. Bryan Foxx, II, RPH
• Franklin House

• All providers in Fort Scott, KS
• Family Medicine Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.