Bryan L Black, MD
Individual provider Active NPI Anesthesiology Physician · Wichita, KS
NPI 1790787380 · NPPES record last updated Jun 16, 2014
Key facts
- NPI
- 1790787380
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- 04-21429 (KS)
- Practice address
- 8080 E Central Ave
Ste 250
Wichita, KS 67206-2361 - Phone
- (316) 686-7327
- Fax
- (316) 686-1557
- NPI assigned
- Aug 12, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Anesthesiology
- Education
- University of South Florida College of Medicine, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Kansas Pain Specialists PA
Practice addresses (Care Compare)
8080 E Central Ave
Suite 250
Wichita, KS 67206-2367
Phone (316) 686-1564
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050415000781 | KS | Practitioner - Anesthesiology | 8224941489 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-21429 | KS | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kansas Spine Anesthesia Corporation PA | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 04-21429 | KS | Yes |
Addresses
Primary practice location
8080 E Central Ave
Ste 250
Wichita, KS 67206-2361
Mailing address
8080 E Central Ave
Ste 250
Wichita, KS 67206-2361
Phone (316) 686-7327
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100113780 A | Medicaid | KS |
Other providers in Wichita, KS
- John Bjerum
- Kirsten Bjorkman
- BKD Clare Bridge of Wichita, LLC
- BKD Sterling House of Wichita-Tallgrass, LLC
- Blade William Black
- Courtney Renee Black
- Danielle Black
- Gretchen Black
- Harrison Black
- Joseph Black
All providers in Wichita, KS · Anesthesiology 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 Jun 16, 2014. 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.
- Order and Referring (CMS).
- 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.