NPIMap

Individual provider Active NPI

Clay Earl Lyddane, MD PHD

  • Urology Physician
  • Wichita, KS
National Provider Identifier
1760641476
Registry record updated Aug 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
04-35145 Issued in KS
Practice address
3311 E Murdock St
Wichita, KS 67208-3054
Phone
(316) 689-9185
Fax
(316) 689-9909
NPI assigned
Jun 6, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X DR.0072509 CO
Urology Physician 208800000X 04-35145 KS Primary

Addresses

Primary practice location

3311 E Murdock St
Wichita, KS 67208-3054

Mailing address

3311 E Murdock St
Wichita, KS 67208-3054
Phone (316) 689-9185

Other practice location 1

1020 Lakeview Ave
Pueblo, CO 81004-3508
Phone (719) 557-4700

Other identifiers 1

IdentifierTypeStateIssuer
200740730AMedicaidKS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240425000698 CO Practitioner - Urology 6901074459 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1020 Lakeview Ave
Pueblo, CO 81004-3508
Phone (719) 557-3777

400 W 16TH St
Pueblo, CO 81003-2745
Phone (719) 584-4921

4100 Jerry Murphy Rd
Pueblo, CO 81001-1046
Phone (719) 542-1500

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection17

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0072509COMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Urology CurrentSince Jun 1, 2025 Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Sep 1, 2025 Accepting new patients
Catholic Health Initiatives Colorado Current Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Jun 1, 2025 Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Sep 1, 2025 Accepting new patients
Catholic Health Initiatives Colorado Past Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

9100 E Mineral Cir
Centennial, CO 80112
Phone (303) 561-5193

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

1100 Carson Ave
La Junta, CO 81050
Phone (719) 383-6000

4100 Jerry Murphy Rd
Pueblo, CO 81001
Phone (719) 544-7070

1020 Lakeview Ave
Pueblo, CO 81004
Phone (719) 557-3145

1619 N Greenwood St
Ste 106
Pueblo, CO 81003
Phone (719) 595-7760

41 State Highway 67
Woodland Park, CO 80863
Phone (719) 686-0551

Organizations & group practices 6

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1212710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1760641476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3311 E MURDOCK ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672083054",
            "telephone_number": "316-689-9185",
            "fax_number": "316-689-9909"
        },
        {
            "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": "316-689-9185",
            "fax_number": "316-689-9909"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1020 Lakeview Ave",
            "address_purpose": "LOCATION",
            "city": "Pueblo",
            "state": "CO",
            "postal_code": "810043508",
            "country_code": "US",
            "telephone_number": "719-557-4700",
            "fax_number": "719-557-4725",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LYDDANE",
        "first_name": "CLAY",
        "middle_name": "EARL",
        "name_prefix": "Dr.",
        "credential": "MD PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-06",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CO",
            "license": "DR.0072509",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "KS",
            "license": "04-35145",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200740730A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.