NPIMap

Individual provider Active NPI

Beau Fry

  • Family Medicine Physician
  • Wichita, KS
National Provider Identifier
1891310678
Registry record updated Jun 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
94-10384 Issued in KS
Practice address
1010 N Kansas St
Wichita, KS 67214-3124
Phone
(316) 293-2665
NPI assigned
Jun 8, 2020
Last updated
Jun 8, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 94-10384 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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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
I20230823000826 NE Practitioner - Family Practice 7214353994 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera St Anthonys HospitalGroup PAC ID 4486548203, shared by 5 NPIs, 23 clinicians

Practice addresses (Care Compare)

110 Park Ave
Chambers, NE 68725-3858
Phone (402) 482-5466

300 N 2ND St
O'Neill, NE 68763-1514
Phone (402) 336-2611

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2821NEMDMental Health Counselor
94-10384KSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Avera St Anthonys Hospital Current Accepting new patients
Avera St Anthonys Hospital CurrentSince Sep 1, 2023 Accepting new patients
Avera St Anthonys Hospital Family Medicine CurrentSince Sep 1, 2023 Accepting new patients
Avera St Anthonys Hospital Current Accepting new patients

Locations

300 N 2nd St
Oneill, NE 68763
Phone (402) 336-2900

300 N 2nd St
Ste 100
Oneill, NE 68763
Phone (402) 336-2900

Interoperability endpoints

  • Direct secure messaging: beau.fry@avera.sdhealthlink.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1591574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591574400000",
    "number": "1891310678",
    "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": [],
    "basic": {
        "last_name": "FRY",
        "first_name": "BEAU",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-08",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "94-10384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.