Elias Chediak IV, M.D.
Individual provider Active NPI Psychiatry Physician · Lawrence, KS
NPI 1528060878 · NPPES record last updated Jan 14, 2014
Key facts
- NPI
- 1528060878
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 14762 (KS)
- Practice address
- 601 Missouri St
Ste 1
Lawrence, KS 66044-2361 - Phone
- (785) 841-7430
- Fax
- (785) 841-6411
- NPI assigned
- Jun 1, 2005
- Reactivated
- Mar 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- Other, 1965
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
601 Missouri St
Suite 1
Lawrence, KS 66044-2361
Phone (785) 841-7430
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 |
|---|---|---|---|---|
| I20050328000752 | KS | Practitioner - Psychiatry | 5799731253 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14762 | KS | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elias Chediak, M.D., P.a. | Current |
Accepting new patients |
Locations
601 Missouri St
Ste 1
Lawrence, KS 66044
Phone (785) 841-7430
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 14762 | KS | Yes |
Addresses
Primary practice location
601 Missouri St
Ste 1
Lawrence, KS 66044-2361
Mailing address
601 Missouri St
Ste 1
Lawrence, KS 66044-2361
Phone (785) 841-7430
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100089000A | Medicaid | KS |
Other providers in Lawrence, KS
- Charles L. Kincaid D.D.S. P.a.
- Susan Marie Chase
- Emilie Chavez
- Lexie Catherine Chavez
- Henry Parker Cheatum
- Gloria J Chediak
- Rebecca L Cheek-King
- Qiannan Chen
- Eleanora Marie Chier
- Mary Childs
All providers in Lawrence, KS · Psychiatry 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 Jan 14, 2014. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.