Gennevieve T Pham, P.A

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

15-01498 Issued in KS

Practice address

3311 E Murdock St
Wichita, KS 67208-3054

Phone

(316) 689-9107

Fax

(316) 689-9354

NPI assigned

Oct 25, 2011

Last updated

Feb 9, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in KS

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Cep America - Kansas LLC

  • Emergency Medicine Physician
  • Wichita, KS
  • NPI 1659768125
  Medicare reassignment NPD
• Carepoint Emergency Medicine Kansas LLC

  • Emergency Medicine Physician
  • Wichita, KS
  • NPI 1477096097
  Medicare reassignment
• Cep America - Kansas LLC

  • Emergency Medicine Physician
  • Wellington, KS
  • NPI 1932704608
  NPD
• Runway Emergency Physicians LLC

  • Emergency Medicine Physician
  • Wichita, KS
  • NPI 1063751352
  NPD (past)

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

{
    "created_epoch": "1319500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423440000000",
    "number": "1730465519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8035",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672080035",
            "telephone_number": "316-689-9135",
            "fax_number": "316-689-9667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3311 E MURDOCK ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672083054",
            "telephone_number": "316-689-9107",
            "fax_number": "316-689-9354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "GENNEVIEVE",
        "middle_name": "T",
        "credential": "P.A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-25",
        "last_updated": "2015-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-01498",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KANSAS LICIENSE",
            "identifier": "15-01498",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200851160B",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "003719256",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laurie Ann Pfeiffer, MHCL, MBA, MPH, BSN
• Jennifer Phetsamone Phachantry, PHARMD
• Alan Pham
• Daisy Pham
• Diemkieu Pham
• Giao Pham, MD
• Kaitlin Lynn Pham
• Kathy Pham
• Kevin Minh-Huy Pham, DMD
• Kimberly Hoang Pham

• 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 Feb 9, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.