Susanna Ciccolari Micaldi, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

04-41077 Issued in KS

Practice address

1001 N. Minneapolis St
Wichita, KS 67214-3127

Phone

(316) 293-2647

Fax

(855) 476-0305

NPI assigned

Jun 27, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Kansas School of Medicine Wichita Medical Practice AssocGroup PAC ID 3577464841, 54 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension Via Christi Hospitals Wichita, Inc. Hospital, Wichita, KS, CCN 170122

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• University of Kansas School of Medicine Wichita Medical Practice Assoc

  • Internal Medicine Physician
  • Wichita, KS
  • NPI 1639143712

  Psychiatry

  Medicare reassignment Care Compare group NPD
• Ascension Via Christi Hospitals Wichita Inc.

  • General Acute Care Hospital
  • Wichita, KS
  • NPI 1154314789
  NPD (past)

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

• Ascension Via Christi Hospitals Wichita Inc.

  • General Acute Care Hospital
  • Wichita, KS
  • NPI 1154314789
  Care Compare affiliation

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

{
    "created_epoch": "1403827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1790190791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 N MINNEAPOLIS ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672143127",
            "telephone_number": "316-293-2647",
            "fax_number": "855-476-0305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 N. MINNEAPOLIS ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672143127",
            "telephone_number": "316-293-2647",
            "fax_number": "855-476-0305"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3600 E Harry St",
            "address_purpose": "LOCATION",
            "city": "Wichita",
            "state": "KS",
            "postal_code": "672183713",
            "country_code": "US",
            "telephone_number": "316-293-2611",
            "fax_number": "316-293-1882",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "929 N Saint Francis Ave",
            "address_purpose": "LOCATION",
            "city": "Wichita",
            "state": "KS",
            "postal_code": "672143821",
            "country_code": "US",
            "telephone_number": "316-293-2611",
            "fax_number": "316-293-1882",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1010 N Kansas St",
            "address_purpose": "LOCATION",
            "city": "Wichita",
            "state": "KS",
            "postal_code": "672143124",
            "country_code": "US",
            "telephone_number": "316-293-2611",
            "fax_number": "316-293-1882",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CICCOLARI MICALDI",
        "first_name": "SUSANNA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-27",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "KS",
            "license": "94-08402",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "KS",
            "license": "04-41077",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "KS",
            "license": "94-08402",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "KS",
            "license": "04-41077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30004664320001",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chrysalis Center, Inc
• Aaron Chu, APRN
• Muhammad Aswab Iqbal Chughtai, MD
• Alycia Chung
• Kacie Lynn Ciarmoli
• Cory Andrew Ciccone, D.O.
• Chloe E Ciero-Lacrosse, RN
• Kathryn J Cillessen, M.D.
• Ricardo Ciniglio, MD
• Circle of Love, Inc

• Child & Adolescent Psychiatry Physician in Wichita, KS
• Providers in Wichita, KS by specialty
• Child & Adolescent Psychiatry Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; 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.