NPIMap

Individual provider Active NPI

Maxwell James Self, M.D.

  • Family Medicine Physician
  • Fort Scott, KS
National Provider Identifier
1497736011
Registry record updated May 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0424746 Issued in KS
Practice address
2322 S Main St
Fort Scott, KS 66701-3026
Phone
(620) 223-8040
Fax
(620) 223-8002
NPI assigned
Nov 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0424746 KS Primary

Addresses

Primary practice location

2322 S Main St
Fort Scott, KS 66701-3026

Mailing address

PO Box 1832
Pittsburg, KS 66762-1832
Phone (620) 231-9873

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS, OK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050510001175 KS Practitioner - Family Practice 1355381260 Reassigns benefits to 1 organization
I20210610003201 OK Practitioner - Family Practice 1355381260 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kansas School of Med (KC/Wich/Sal), 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Health Center of Southeast Kansas IncGroup PAC ID 7911816392, shared by 26 NPIs, 111 clinicians

Practice addresses (Care Compare)

106 NW Veterans Blvd
Miami, OK 74354-1818
Phone (918) 238-2410

2322 S Main St
Fort Scott, KS 66701-3026
Phone (622) 022-3804

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0424746KSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Center of Southeast Kansas, Inc. CurrentSince Mar 30, 2021 Accepting new patients
Community Health Center of Southeast Kansas Inc CurrentSince Dec 31, 2018 Accepting new patients
Community Health Center of Southeast Kansas Inc CurrentSince Dec 31, 2018 Accepting new patients
Medicalodges, Inc. Past Accepting new patients

Locations

401 Woodland Hills Blvd
Fort Scott, KS 66701
Phone (620) 223-2200

2322 S Main St
Fort Scott, KS 66701
Phone (620) 223-0135

1017 E Market St
Lacygne, KS 66040
Phone (913) 757-4575

3011 N Michigan St
Pittsburg, KS 66762
Phone (620) 231-1960

11155 Tucker Rd
Pleasanton, KS 66075
Phone (913) 347-8110

106 NW Veterans Blvd
Miami, OK 74354
Phone (918) 238-2410

7 S 1st St
Wyandotte, OK 74370
Phone (918) 533-9717

Interoperability endpoints

  • Direct secure messaging: maxwell.self@chcsek.eclinicaldirectplus.com
  • Direct secure messaging: mself1035@directa.mercy.net

Organizations & group practices 4

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

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1497736011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1832",
            "city": "PITTSBURG",
            "state": "KS",
            "postal_code": "667621832",
            "telephone_number": "620-231-9873",
            "fax_number": "620-240-5062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2322 S MAIN ST",
            "city": "FORT SCOTT",
            "state": "KS",
            "postal_code": "667013026",
            "telephone_number": "620-223-8040",
            "fax_number": "620-223-8002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELF",
        "first_name": "MAXWELL",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "0424746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Scott, KS

Sources for this page

Verify at the official NPI Registry.