Individual provider Active NPI

Khalida M Mahdi

  • Family Medicine Physician
  • Wichita, KS
National Provider Identifier
1609063312
Registry record updated Aug 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
04-33778 Issued in KS
Practice address
3311 E Murdock St
Wichita, KS 67208-3054
Phone
(316) 689-9107
Fax
(316) 689-9354
NPI assigned
Sep 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2015

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 04-33778 KS Primary

Addresses

Primary practice location

3311 E Murdock St
Wichita, KS 67208-3054

Mailing address

PO Box 8035
Wichita, KS 67208-0035
Phone (316) 689-9135

Other identifiers 2

IdentifierTypeStateIssuer
200974390AMedicaidKS
003719259OtherMEDICARE

Other names 1

  • Khalida M Kadhum Former name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130424000797 KS Practitioner - Family Practice 1052557782 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1993
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

3809 S Greystone CT
Suite B
Springfield, MO 65804-6561

PO Box
Suite 8035
Wichita, KS 67208

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
04-33778KSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group Via Christi, PA CurrentSince Jan 24, 2013 Accepting new patients
Ascension Medical Group Via Christi, PA CurrentSince Jan 24, 2013 Accepting new patients
Williams Medical Group Practice, LLC CurrentSince Jan 15, 2019 Accepting new patients
Williams Medical Group Practice, LLC Family Medicine CurrentSince Jan 15, 2019 Accepting new patients

Locations

231 S Andover Rd
Andover, KS 67002
Phone (316) 733-9355

445 W 15th St
Liberal, KS 67901
Phone (620) 417-9012

3311 E Murdock St
Wichita, KS 67208
Phone (316) 689-9107

8444 W 21st St N
Wichita, KS 67205
Phone (316) 274-9850

777 NW 63rd St
Fl 2
Oklahoma City, OK 73116

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439769600000",
    "number": "1609063312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8035",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672080035",
            "telephone_number": "316-689-9135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3311 E MURDOCK ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672083054",
            "telephone_number": "316-689-9107",
            "fax_number": "316-689-9354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHDI",
        "first_name": "KHALIDA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-26",
        "last_updated": "2015-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-33778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200974390A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "003719259",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KHALIDA",
            "last_name": "KADHUM",
            "middle_name": "M",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.