Travis Glenn Whitesides, PA-C
Individual provider Active NPI Medical Physician Assistant · Burlington, KS
NPI 1689923732 · NPPES record last updated Sep 23, 2019
Key facts
- NPI
- 1689923732
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 15-01559 (KS)
- Practice address
- 309 Sanders St
Burlington, KS 66839-2616 - Phone
- (620) 364-2121
- NPI assigned
- Sep 5, 2012
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- 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 |
|---|---|---|---|---|
| I20190710002957 | MO | Practitioner - Physician Assistant | 6507018280 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019017032 | MO | MD | Physician Assistant |
| 15-01559 | KS | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Curators of the University of Missouri | Current |
Accepting new patients |
Locations
1 Hospital Dr
Columbia, MO 65212
Phone (573) 882-2568
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2019017032 | MO | |
| Medical Physician Assistant | 363AM0700X | 15-01559 | KS | Yes |
Addresses
Primary practice location
309 Sanders St
Burlington, KS 66839-2616
Mailing address
309 Sanders St
Burlington, KS 66839-2616
Other practice location 1
One Hospital Dr
Columbia, MO 65212-0001
Phone (573) 884-4400
Other providers in Burlington, KS
- Solid Ground Counseling Center LLC
- Susie Decker Case Management Services LLC
- Therapy Services LLC
- Thrive Integrated Behavioral Health and Wellness
- Jordan Weber
- Jessica Jo Williams
- Rose Winkler
All providers in Burlington, KS · Medical 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 23, 2019. 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.