Wichita Diabetes and Endocrinology, LLC
Organization Active NPI Endocrinology, Diabetes & Metabolism Physician · Wichita, KS
NPI 1770080673 · NPPES record last updated Nov 1, 2022
Key facts
- NPI
- 1770080673
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Endocrinology, Diabetes & Metabolism Physician 207RE0101X
- Legal business name
- WICHITA DIABETES AND ENDOCRINOLOGY, LLC
- Practice address
- 8110 E 32ND St N Ste 125
Wichita, KS 67226-2644 - Phone
- (316) 330-3636
- Fax
- (866) 378-4552
- NPI assigned
- Apr 9, 2018
- Organization subpart
- No
Authorized official
- Name
- Aubry Mae Boyce
- Title
- Clinic Manager
- Phone
- (316) 330-3636
Practitioners 8
-
Julia Bippert, RLD, CDE
-
Georges Elhomsy, MD
-
Molly Wiwi, APRN, FNP-C
-
Jerrod A. Conkling, P.A.
-
Jason James Menges, PA-C
-
Payden Mae Shapland, PA-C
-
Ellen E. Borst, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D2150132 | Wichita Diabetes and Endocrinology, LLC | Certificate of waiver | Jun 17, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180508002619 | KS | Part B Supplier - Clinic/Group Practice | 1052675592 |
Receives reassigned benefits from 7 practitioners Practice locations: Derby, KS; Newton, KS; Wichita, KS; Winfield, KS |
National Provider Directory
Locations
800 Medical Center Dr
Fl 2
Newton, KS 67114
Phone (316) 330-3636
8110 E 32nd St N
Wichita, KS 67226
Phone (316) 315-6662
8110 E 32nd St N
Ste 125
Wichita, KS 67226
Phone (316) 330-3636
8200 W Central Ave
Ste 1
Wichita, KS 67212
Phone (316) 721-4544
Interoperability endpoints
- https://api.platform.athenahealth.com/17686/brand/1/csg/1/fhir/r4
- georges.elhomsy.1@17686.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endocrinology, Diabetes & Metabolism Physician |
207RE0101X | Yes |
Addresses
Primary practice location
8110 E 32ND St N Ste 125
Wichita, KS 67226-2644
Mailing address
8110 E 32ND St N Ste 125
Wichita, KS 67226-2623
Phone (316) 330-3636
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | georges.elhomsy.1@17686.direct.athenahealth.com | ||
| Direct Messaging Address | georges.elhomsy.1@17686.direct.athenahealth.com |
Other providers in Wichita, KS
- Wichita Clinic, PA
- Wichita Critical Care Services LLC
- Wichita Dental Group at Founders Circle LLC
- Wichita Dental Group PA
- Wichita Dermatology LLC Moeller Dermatology
- Wichita Diagnostic Pathology LLC
- Wichita Disability Consultants
- Wichita Ear Clinic, PA
- Wichita Echocardiographers LLC
- Wichita Endocrinology, LLC
All providers in Wichita, KS · Endocrinology, Diabetes & Metabolism Physician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.