Active NPI
Adam Wetzel, MD
- Psychiatry Physician
- Leavenworth, KS
National Provider Identifier
1578096822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 04-46512
- Practice address
- 4104 S 4TH St
Leavenworth, KS 66048-5082 - Phone
- (785) 580-6100
- NPI assigned
- Apr 4, 2017
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 04-46512 | KS | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | 04-46512 | KS | Primary |
Addresses
Primary practice location
4104 S 4TH St
Leavenworth, KS 66048-5082
Mailing address
1100 N 2ND St Apt 429
Leavenworth, KS 66048-1565
Phone (785) 580-6100
Other practice location 1
3901 Rainbow Blvd
Kansas City, KS 66160-8500
Phone (913) 945-6810
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 |
|---|---|---|---|---|
| I20170824001326 | KS | Order and Referring Only - Internal Medicine | 6709158884 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-46512 | KS | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733356800000",
"number": "1578096822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 N 2ND ST APT 429",
"city": "LEAVENWORTH",
"state": "KS",
"postal_code": "660481565",
"telephone_number": "785-580-6100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4104 S 4TH ST",
"city": "LEAVENWORTH",
"state": "KS",
"postal_code": "660485082",
"telephone_number": "785-580-6100"
}
],
"practiceLocations": [
{
"address_1": "3901 Rainbow Blvd",
"address_purpose": "LOCATION",
"city": "Kansas City",
"state": "KS",
"postal_code": "661608500",
"country_code": "US",
"telephone_number": "913-945-6810",
"fax_number": "913-588-0240",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WETZEL",
"first_name": "ADAM",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-04-04",
"last_updated": "2024-12-05",
"certification_date": "2024-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "KS",
"license": "04-46512",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "KS",
"license": "04-46512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leavenworth, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 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.