Marisa Reese, PA-C – Physician Assistant

Key facts

NPI: 1689009573
Entity type: Individual (NPI type 1)
Primary specialty: Physician Assistant 363A00000X
License: T-03785 (KS)
Practice address: 9390 E Central Ave
Suite 102
Wichita, KS 67206-2533
Phone: (316) 733-4747
Fax: (316) 733-5253
NPI assigned: Sep 10, 2013
Sex: Female
Sole proprietor: No

Organizations & group practices 1

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.

Andover Family Medicine, LLC Primary Care Clinic/Center · Andover, KS · NPI 1124067558

Medicare reassignment Care Compare group KS

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Kansas Medical Center LLC General Acute Care Hospital · Andover, KS · NPI 1255380127

Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty: Physician Assistant
Education: Other, 2013
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Andover Family Medicine LLC (13 clinicians)

Practice addresses (Care Compare)

2117 Keystone Cir
Andover, KS 67002-8749
Phone (316) 733-5120

Hospital & facility affiliations

Kansas Medical Center LLC Hospital · Andover, KS · CCN 170197

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
I20151023000707	KS	Practitioner - Physician Assistant	9638488117	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Physician Assistant

State licenses

License	State	Type	Specialty
T-03785	KS	MD	Physician Assistant

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physician Assistant	363A00000X	T-03785	KS	Yes

Addresses

Primary practice location

9390 E Central Ave
Suite 102
Wichita, KS 67206-2533

Mailing address

9390 E Central Ave
Suite 102
Wichita, KS 67206-2533
Phone (316) 733-4747

Other providers in Wichita, KS

All providers in Wichita, KS · Physician Assistant in Kansas

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2013. 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.

Verify at the official NPI Registry.