Individual provider Active NPI

Micheal R Covault, MD

  • Anesthesiology Physician
  • Andover, KS
National Provider Identifier
1689676298
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
04-30920 Issued in KS
Practice address
1124 West 21St Street
Andover, KS 67002
Phone
(316) 300-4000
NPI assigned
Aug 12, 2005
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 04-30920 KS Primary

Addresses

Primary practice location

1124 West 21St Street
Andover, KS 67002

Mailing address

7718 E Oakmount St
Wichita, KS 67226-3527
Phone (316) 315-0621

Other identifiers 1

IdentifierTypeStateIssuer
200330190AMedicaidKS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130202000046 MS Practitioner - Anesthesiology 7012944317 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Consultants PAGroup PAC ID 4486637881, 102 clinicians

Practice addresses (Care Compare)

2100 Hwy 61 N
Vicksburg, MS 39183-8211
Phone (601) 883-5000

2500 N State St
Jackson, MS 39216-4500
Phone (601) 898-4404

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
04-30920KSMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Anesthesia Group, P.a. Anesthesiology CurrentSince Dec 15, 2022 Accepting new patients
Anesthesia Consultants PA Anesthesiology CurrentSince Dec 1, 2023 Accepting new patients
Jackson Anesthesia Associates PA Anesthesiology CurrentSince Dec 1, 2013 Accepting new patients
Wichita Anesthesiology Chartered Anesthesiology Past Accepting new patients

Locations

1053 River Oaks Dr
#C
Flowood, MS 39232
Phone (601) 969-1430

1030 River Oaks Dr
Jackson, MS 39232
Phone (601) 376-2165

971 Lakeland Dr
Jackson, MS 39216
Phone (601) 939-5922

2100 Highway 61 N
Vicksburg, MS 39183
Phone (601) 883-5001

Interoperability endpoints

  • Direct secure messaging: mcovault219398@ummc.direct-ci.com

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689676298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7718 E OAKMOUNT ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672263527",
            "telephone_number": "316-315-0621",
            "fax_number": "316-315-0621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 WEST 21ST STREET",
            "city": "ANDOVER",
            "state": "KS",
            "postal_code": "67002",
            "telephone_number": "316-300-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COVAULT",
        "first_name": "MICHEAL",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "KS",
            "license": "04-30920",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200330190A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Andover, KS

Sources for this page

Verify at the official NPI Registry.