Sean-Carlo Prolago, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

15-00662 Issued in KS

Practice address

4722 W Kellogg Dr
Wichita, KS 67209-2508

Phone

(316) 440-2565

Fax

(316) 440-2750

NPI assigned

Oct 16, 2006

Last updated

Mar 30, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 4

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premier Phlebology, LLCGroup PAC ID 9436207164, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: sean.prolago.p1@direct.innovativevein.nextgenshare.com

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.

• Premier Phlebology, LLC

  • Phlebology Physician
  • Wichita, KS
  • NPI 1740420520
  Medicare reassignment Care Compare group
• Emergency Services, PA

  • Emergency Medicine Physician
  • Wichita, KS
  • NPI 1629028881
  NPD (past)
• Galichia Medical Group, P.a.

  • Cardiovascular Disease Physician
  • Wichita, KS
  • NPI 1447238621
  NPD (past)
• Pawnee Valley Community Hospital Inc

  dba Pawnee Valley Community Hospital Family Medicine

  • General Practice Physician
  • Larned, KS
  • NPI 1912310822
  NPD (past)
• Runway Emergency Physicians LLC

  • Emergency Medicine Physician
  • Wichita, KS
  • NPI 1063751352
  NPD (past)

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1619057791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4722 W KELLOGG DR",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672092508",
            "telephone_number": "316-440-2565",
            "fax_number": "316-440-2750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4722 W KELLOGG DR",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672092508",
            "telephone_number": "316-440-2565",
            "fax_number": "316-440-2750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROLAGO",
        "first_name": "SEAN-CARLO",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-00662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "billing@imcwichita.com",
            "affiliation": "N",
            "address_1": "3560 N Maize Rd Ste 106",
            "city": "Wichita",
            "state": "KS",
            "country_code": "US",
            "postal_code": "672057393",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "billing@imcwichita.com",
            "affiliation": "N",
            "address_1": "4722 W Kellogg Dr",
            "city": "Wichita",
            "state": "KS",
            "country_code": "US",
            "postal_code": "672092508",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "billing@imcwichita.com",
            "affiliation": "N",
            "address_1": "5838 E Central Ave",
            "city": "Wichita",
            "state": "KS",
            "country_code": "US",
            "postal_code": "672084203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "billing@imcwichita.com",
            "affiliation": "N",
            "address_1": "7030 S Broadway Ave",
            "city": "Haysville",
            "state": "KS",
            "country_code": "US",
            "postal_code": "670601471",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Progressive Home Health Care Inc (Progressive Home Health & Hospice)
• Progressive Home Health Care Inc (Progressive Home Health & Hospice)
• Progressive Orthotic & Prosthetic Services, Inc.
• Progressive Physical Therapy & Out Patient Rehab, LLC
• Daniel J Prohaska, MD
• Prolinq Solutions LLC
• Promed Physican Services, P.a.
• Promises Kept, LLC (Phoenix Home Care & Hospice)
• Pronab K Sensarma MD PA
• Frank Provenzano, MD

• Physician Assistant in Wichita, KS
• Providers in Wichita, KS by specialty
• Physician Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.