Form Associates, P.a.

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

Legal business name

FORM ASSOCIATES, P.A.

Practice address

801 E Douglas Ave FL 2
Wichita, KS 67202-3548

Phone

(617) 505-1520

Fax

(617) 928-8401

NPI assigned

May 19, 2023

Organization subpart

No

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

Authorized official

Name

Troy Russell, MD

Title

Owner

Phone

(617) 505-1520

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Tax ID family

Form Associates PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Form Associates, P.a.

  • Endocrinology, Diabetes & Metabolism Physician
  • Wichita, KS
  • NPI 1003636143
  NPD tax ID

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rebecca Lorene Popp, APRN

  • Family Nurse Practitioner
  • Wichita, KS
  • NPI 1255987079
  Medicare reassignment NPD (past)
• Emilija Rosenthal, NP

  • Family Nurse Practitioner
  • Dallas, TX
  • NPI 1710485479

  KS

  Medicare reassignment
• Elizabeth A Lowden, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Chicago, IL
  • NPI 1568783991
  NPD

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

{
    "created_epoch": "1684454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773792000000",
    "number": "1740971605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 STATE ST.",
            "address_2": "5TH FL",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021092906",
            "telephone_number": "617-505-1520",
            "fax_number": "617-928-8401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E DOUGLAS AVE FL 2",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672023548",
            "telephone_number": "617-505-1520",
            "fax_number": "617-928-8401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORM ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-19",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-505-1520",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Christina Marie Foreman, PT
• Destiny Danielle Forge, LPC
• John K Forge, M.D.
• Form Associates, P.a.
• Fornelli Feet PA
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• Kathy Forred, MD
• Lindsay L Forrester, APRN
• Joshua Cody Forsberg, DNP, APRN-C

• Endocrinology, Diabetes & Metabolism Physician in Wichita, KS
• Providers in Wichita, KS by specialty
• Endocrinology, Diabetes & Metabolism Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.