Roger J Bidwell, ARNP
Individual provider Active NPI Nurse Practitioner · Tonganoxie, KS
NPI 1669425385 · NPPES record last updated Jan 7, 2011
Key facts
- NPI
- 1669425385
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 44815 (KS)
- Practice address
- 21107 Donahoo Rd
Tonganoxie, KS 66086-4153 - Phone
- (913) 742-4084
- Fax
- (913) 742-4086
- NPI assigned
- May 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
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: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050924000194 | KS | Practitioner - Nurse Practitioner | 1254365612 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 128639 | MO | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid America Senior Management LLC | Current |
Accepting new patients | |
| Mid America Senior Management Aco LLC | Current |
Accepting new patients | |
| Hospitalist Medicine Physicians of Texas, PLLC | Nurse Practitioner | Current |
Accepting new patients |
Locations
520 E Morse Ave
Bonner Springs, KS 66012
Phone (913) 441-2515
9100 Park St
#202B
Lenexa, KS 66215
Phone (913) 438-4286
929 N Saint Francis Ave
Wichita, KS 67214
Phone (316) 291-4396
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 44815 | KS | Yes |
| Nurse Practitioner | 363L00000X | 128639 | MO |
Addresses
Primary practice location
21107 Donahoo Rd
Tonganoxie, KS 66086-4153
Mailing address
21107 Donahoo Rd
PO Box 996
Tonganoxie, KS 66086-4153
Phone (913) 742-4084
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 26279011 | Other | BC/BS | |
| 100347550A | Medicaid | KS | |
| 500008410 | Other | RAILROAD MEDICARE |
Other names
- Mr. Roger J Bidwell
Other providers in Tonganoxie, KS
- Back in Line Chiropractic LLC
- Timothy Badger
- Madeline Baltz
- Kelsey Ann Berry
- Beverly Enterprises - Kansas, LLC
- Laura Bohne
- Heather Lynn Boos
- Alison Shay Bounds
- Stacey Bowman
- Susan Bozarth
All providers in Tonganoxie, KS · Nurse Practitioner 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 7, 2011. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.