Erickson Medical Clinic, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

IN PROGRESS Issued in KS

Legal business name

ERICKSON MEDICAL CLINIC, LLC

Practice address

409 Lincoln Ave
Clay Center, KS 67432-2907

Phone

(785) 632-6415

NPI assigned

Apr 28, 2016

Last updated

Apr 28, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kent Edwin Erickson, M.D.NPI 1073516035

Title

President, Member, Owner

Phone

(785) 632-6415

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kent Edwin Erickson, MD

  • Family Medicine Physician
  • Clay Center, KS
  • NPI 1073516035
  Medicare reassignment Care Compare group NPD Authorized official
• Kathryn Ann Heins-Erickson, APRN

  • Adult Health Nurse Practitioner
  • Clay Center, KS
  • NPI 1861852469
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1461801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461801600000",
    "number": "1689029464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1024 LANE ST",
            "city": "CLAY CENTER",
            "state": "KS",
            "postal_code": "674322211",
            "telephone_number": "785-632-6415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 LINCOLN AVE",
            "city": "CLAY CENTER",
            "state": "KS",
            "postal_code": "674322907",
            "telephone_number": "785-632-6415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERICKSON MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-28",
        "last_updated": "2016-04-28",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "EDWIN",
        "authorized_official_title_or_position": "PRESIDENT, MEMBER, OWNER",
        "authorized_official_telephone_number": "785-632-6415",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "KS",
            "license": "IN PROGRESS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "18630",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100208950A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "003863",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• County of Clay
• County of Clay (Clay County Health Department)
• Mary Kay Cummins, ARNP
• Tricia Aubrey Cunningham
• Emily Elizabeth Ebert, FNP-C
• Kent Edwin Erickson, MD
• Joseph Garrett Ferguson, DDS
• Jericho Fief, COTA
• Joshua B Girard, D.C.
• Austin Keith Gydesen, APRN

• Primary Care Clinic/Center in Clay Center, KS
• Providers in Clay Center, KS by specialty
• Primary Care Clinic/Center in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.