NPIMap

Individual provider Active NPI

Paulo R. De Andrade, M.D.

  • Family Medicine Physician
  • Wakeeney, KS
National Provider Identifier
1861783490
Registry record updated Jul 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
04-36496 Issued in KS
Practice address
320 N 13TH St
Wakeeney, KS 67672-2002
Phone
(785) 743-2182
Fax
(785) 743-6317
NPI assigned
Apr 30, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2013

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X P4153 TX
Family Medicine Physician 207Q00000X 28015 OK
Family Medicine Physician 207Q00000X 04-36496 KS Primary

Addresses

Primary practice location

320 N 13TH St
Wakeeney, KS 67672-2002

Mailing address

320 N 13TH St
Wakeeney, KS 67672-2002
Phone (785) 743-2182

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130820000947 KS Practitioner - Family Practice 4688816770 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Trego County Lemke Memorial HospitalGroup PAC ID 6103735717, 19 clinicians

Practice addresses (Care Compare)

333 N 14TH St
Wakeeney, KS 67672-3000
Phone (785) 743-2124

Hospital & facility affiliations

  • Angels Care Home Health of Dodge City Home health agency, Wa Keeney, KS, CCN 178116
  • Good Samaritan Home Health of Central Kansas Home health agency, Hays, KS, CCN 178064
  • Trego County Lemke Memorial Hospital Hospital, Wakeeney, KS, CCN 171355
  • Hays Medical Center Hospital, Hays, KS, CCN 170013
  • Graham County Hospital Hospital, Hill City, KS, CCN 171325
  • Good Samaritan - Ellis Nursing home, Ellis, KS, CCN 175328
  • Good Samaritan - Hays Nursing home, Hays, KS, CCN 175322
  • Trego County Lemke Memorial Hospital Nursing home, CCN 17Z355

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
04-36496KSMDFamily Medicine Physician
28015OKMDFamily Medicine Physician
P4153TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trego County Lemke Memorial Hospital CurrentSince Jan 1, 2026 Accepting new patients
The Evangelical Lutheran Good Samaritan Society Past Accepting new patients
Trego County Lemke Memorial Hospital Past Accepting new patients
The Evangelical Lutheran Good Samaritan Society Past Accepting new patients
Trego County Lemke Memorial Hospital Past Accepting new patients

Locations

320 N 13th St
Wakeeney, KS 67672
Phone (785) 743-2182

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/235ba15f-6bef-42d8-831c-5f3f60c7755f/

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Trego County Lemke Memorial HospitalWakeeney, KS, CCN 171355 Hospital Other Jan 31, 2023
Good Samaritan - EllisEllis, KS, CCN 175328 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2023
Jan 1, 2023
Good Samaritan Society - HaysHays, KS, CCN 175322 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2023
Jan 1, 2023
Ellis Family Care CenterEllis, KS, CCN 178538 Rural health clinic W-2 Managing Employee Jan 31, 2023

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1304121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374019200000",
    "number": "1861783490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 N 13TH ST",
            "city": "WAKEENEY",
            "state": "KS",
            "postal_code": "676722002",
            "telephone_number": "785-743-2182",
            "fax_number": "785-743-6317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 N 13TH ST",
            "city": "WAKEENEY",
            "state": "KS",
            "postal_code": "676722002",
            "telephone_number": "785-743-2182",
            "fax_number": "785-743-6317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE ANDRADE",
        "first_name": "PAULO",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-30",
        "last_updated": "2013-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "P4153",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "28015",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-36496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wakeeney, KS

Sources for this page

Verify at the official NPI Registry.