Spectrum Family Medical Clinic, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0422366 Issued in KS

Legal business name

SPECTRUM FAMILY MEDICAL CLINIC, PA

Practice address

2020 N Tyler
Ste 114
Wichita, KS 67212-4916

Phone

(316) 462-0460

Fax

(316) 462-0465

NPI assigned

Apr 25, 2006

Last updated

Oct 5, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Phaedra M Mann

Title

Office Manager

Phone

(316) 462-0460

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joseph M Sack, MD, CMD

  • Family Medicine Physician
  • Wichita, KS
  • NPI 1962475343
  Medicare reassignment NPD

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507161600000",
    "number": "1912963067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 N TYLER",
            "address_2": "STE 114",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672124916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 N TYLER",
            "address_2": "STE 114",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672124916",
            "telephone_number": "316-462-0460",
            "fax_number": "316-462-0465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM FAMILY MEDICAL CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2017-10-05",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "PHAEDRA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "316-462-0460",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "0422366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100112800C",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Specialists in Laboratory Medicine LLC
• Specialized Hospice
• Specialized Hospice LLC
• Specs Optical
• Specs Wichita
• Speech Swallowing and Voice Center PA
• Alyssa L Spencer, LMSW
• Heather A Spencer, LSCSW, LMAC, CHT
• Joseph B Spencer, PT
• Keri Dawn Spencer, NP-C

• Family Medicine Physician in Wichita, KS
• Providers in Wichita, KS by specialty
• Family Medicine Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.