Diemkieu Pham

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

15-02552 Issued in KS

Practice address

2230 N Ridge Rd
Wichita, KS 67205-1053

Phone

(316) 448-8339

Fax

(316) 221-7149

NPI assigned

May 26, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Kieu Pham Other name

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

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wichita Primary Care LLCGroup PAC ID 7911243316, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Wichita Primary Care LLC

  • Family Medicine Physician
  • Wichita, KS
  • NPI 1164908281
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1621987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1780259192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2230 N RIDGE RD",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672051053",
            "telephone_number": "316-448-8339",
            "fax_number": "316-221-7149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 N RIDGE RD",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672051053",
            "telephone_number": "316-448-8339",
            "fax_number": "316-221-7149"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7627 E 37th St N Apt 2903",
            "address_purpose": "LOCATION",
            "city": "Wichita",
            "state": "KS",
            "postal_code": "672262809",
            "country_code": "US",
            "telephone_number": "316-299-3596",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "DIEMKIEU",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-26",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "15-02552",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-02552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIEU",
            "last_name": "PHAM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kelly Pfeiffer
• Laurie Ann Pfeiffer, MHCL, MBA, MPH, BSN
• Jennifer Phetsamone Phachantry, PHARMD
• Alan Pham
• Daisy Pham
• Gennevieve T Pham, P.A
• Giao Pham, MD
• Kaitlin Lynn Pham
• Kathy Pham
• Kevin Minh-Huy Pham, DMD

• 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 Sep 8, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.