Individual provider Active NPI

Jeremy D Bender, D.C.

  • Chiropractor
  • Wichita, KS
National Provider Identifier
1720173941
Registry record updated Nov 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
04869 Issued in KS
Practice address
813 W Douglas Ave
Wichita, KS 67213-4704
Phone
(316) 440-4052
NPI assigned
Oct 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 04869 KS Primary

Addresses

Primary practice location

813 W Douglas Ave
Wichita, KS 67213-4704

Mailing address

813 W Douglas Ave
Wichita, KS 67213-4704
Phone (316) 440-4052

Other identifiers 2

IdentifierTypeStateIssuer
062077OtherKSBLUE CROSS
062098OtherKSALLL OTHERS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040609000331 KS Practitioner - Chiropractic 6901889237 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Cleveland Chiropractic College - Kansas City, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2290 N Tyler Rd
Suite 100
Wichita, KS 67205-8760
Phone (316) 721-3003

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
04869KSMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Paul J. Willert Chiropractic LLC Chiropractor CurrentSince Nov 17, 2019 Accepting new patients
Bender Chiropractic, PA Chiropractor CurrentSince Nov 1, 2019 Accepting new patients

Locations

813 W Douglas Ave
Wichita, KS 67213
Phone (316) 440-4052

2290 N Tyler Rd
Ste 100
Wichita, KS 67205
Phone (316) 721-0011

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572566400000",
    "number": "1720173941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "813 W DOUGLAS AVE",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672134704",
            "telephone_number": "316-440-4052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "813 W DOUGLAS AVE",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672134704",
            "telephone_number": "316-440-4052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENDER",
        "first_name": "JEREMY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2019-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "KS",
            "license": "04869",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "062077",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALLL OTHERS",
            "identifier": "062098",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2019; 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.