Active NPI
Elizabeth Wall, DO
- Surgery Physician
- Wichita, KS
National Provider Identifier
1780374892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 94-11883
- Practice address
- 1010 N Kansas St
Wichita, KS 67214-3124 - Phone
- (316) 293-2665
- NPI assigned
- May 11, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Surgery Physician | 208600000X | 94-11883 | KS | Primary |
Addresses
Primary practice location
1010 N Kansas St
Wichita, KS 67214-3124
Mailing address
1010 N Kansas St
Wichita, KS 67214-3124
Phone (316) 293-2665
Other practice location 1
1401 E Central Dr
Meridian, ID 83642-8046
Phone (208) 795-4343
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240627002842 | KS | Order and Referring Only - General Surgery | 2163966482 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 94-11883 | KS | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718496000000",
"number": "1780374892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1010 N KANSAS ST",
"city": "WICHITA",
"state": "KS",
"postal_code": "672143124",
"telephone_number": "316-293-2665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 N KANSAS ST",
"city": "WICHITA",
"state": "KS",
"postal_code": "672143124",
"telephone_number": "316-293-2665"
}
],
"practiceLocations": [
{
"address_1": "1401 E Central Dr",
"address_purpose": "LOCATION",
"city": "Meridian",
"state": "ID",
"postal_code": "836428046",
"country_code": "US",
"telephone_number": "208-795-4343",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALL",
"first_name": "ELIZABETH",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-11",
"last_updated": "2024-06-16",
"certification_date": "2024-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "KS",
"license": "94-11883",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.