Active NPI
Roy Ghanem
- Pediatrics Physician
- Wichita, KS
National Provider Identifier
1497574693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 94-12070
- Practice address
- 550 N Hillside St
Wichita, KS 67214-4976 - Phone
- (316) 962-2000
- NPI assigned
- Oct 7, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 94-12070 | KS | Primary |
Addresses
Primary practice location
550 N Hillside St
Wichita, KS 67214-4976
Mailing address
1945 N Rock Rd Apt 605
Wichita, KS 67206-1227
Phone (316) 236-2342
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: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241109000441 | KS | Order and Referring Only - Pediatric Medicine | 6406380740 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- roy.ghanem@hca3.eclinicaldirectplus.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728259200000",
"number": "1497574693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1945 N ROCK RD APT 605",
"city": "WICHITA",
"state": "KS",
"postal_code": "672061227",
"telephone_number": "316-236-2342"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 N HILLSIDE ST",
"city": "WICHITA",
"state": "KS",
"postal_code": "672144976",
"telephone_number": "316-962-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHANEM",
"first_name": "ROY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-10-07",
"last_updated": "2024-10-07",
"certification_date": "2024-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "KS",
"license": "94-12070",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.