Individual provider Active NPI

Hannah L Roth, PA-C

  • Physician Assistant
  • Wichita, KS
National Provider Identifier
1770057812
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
15-02185 Issued in KS
Practice address
2626 N Webb Rd
Wichita, KS 67226-8110
Phone
(316) 636-6127
Fax
(316) 636-5813
NPI assigned
Jan 11, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X
Physician Assistant 363A00000X 15-02185 KS Primary

Addresses

Primary practice location

2626 N Webb Rd
Wichita, KS 67226-8110

Mailing address

2626 N Webb Rd
Wichita, KS 67226-8110
Phone (166) 366-1273

Other names 1

  • Hannah L Weaver Former name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20190220002087 KS Practitioner - Physician Assistant 6608114434 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Oklahoma College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wichita Urology Group PAGroup PAC ID 7214904499, 29 clinicians

Practice addresses (Care Compare)

2626 N Webb Rd
Wichita, KS 67226-8110
Phone (316) 636-6100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
15-02185KSMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kansas Spine Anesthesia Corporation PA PastSince Jun 9, 2024 Accepting new patients

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1547164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1770057812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2626 N WEBB RD",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672268110",
            "telephone_number": "166-366-1273",
            "fax_number": "316-636-5813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2626 N WEBB RD",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672268110",
            "telephone_number": "316-636-6127",
            "fax_number": "316-636-5813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "HANNAH",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-11",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-02185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HANNAH",
            "last_name": "WEAVER",
            "middle_name": "L",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.