Mary J Dagenais, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

15-00874 Issued in KS

Practice address

9415 E Harry St Ste 602
Wichita, KS 67207-5082

Phone

(316) 681-2420

Fax

(316) 681-3561

NPI assigned

Aug 18, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK, KS2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Midwest Physiatrists PAGroup PAC ID 4183613607, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Midwest Physiatrists, PA

  • Specialist
  • Wichita, KS
  • NPI 1508937228
  Medicare reassignment Care Compare group
• Pawhuska Hospital, Inc.

  • Critical Access Hospital
  • Pawhuska, OK
  • NPI 1174521991
  Medicare reassignment

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731628800000",
    "number": "1689666364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9415 E HARRY ST STE 602",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672075082",
            "telephone_number": "316-681-2420",
            "fax_number": "316-681-3561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9415 E HARRY ST STE 602",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672075082",
            "telephone_number": "316-681-2420",
            "fax_number": "316-681-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAGENAIS",
        "first_name": "MARY",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-18",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1218",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-00874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bunny B Czarnopys, LSCSW, LCMFT
• D & T Management Group LLC (Balanced Arches)
• Shubika D'Souza
• D&R Tender Loving Care HHS, LLC
• Aimee Daccache, MD
• Dana Daggett, ARNP
• Christine Marie Dahl
• Nancy Dahlinger, OTR
• Jenna Dahms, LSCSW
• Dong Dai, 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 Nov 15, 2024; 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.