NPIMap

Organization Active NPI

Hillside Medical Office LLC

  • Family Medicine Physician
  • Wichita, KS
National Provider Identifier
1912969486
Registry record updated Jun 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HILLSIDE MEDICAL OFFICE LLC
Practice address
855 N Hillside St
Wichita, KS 67214-4913
Phone
(316) 685-1381
NPI assigned
Apr 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2009

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

Authorized official

Name
Mr. David A Gordon, CPA
Title
Manager
Phone
(316) 685-1381

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X KS Primary

Addresses

Primary practice location

855 N Hillside St
Wichita, KS 67214-4913

Mailing address

855 N Hillside St
Wichita, KS 67214-4913
Phone (316) 685-1381

Other identifiers 2

IdentifierTypeStateIssuer
16399OtherKSBC/BS GROUP NUMBER
100087950AMedicaidKS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050413001128 KS Part B Supplier - Clinic/Group Practice 6709823453 Receives reassigned benefits from 9 practitioners
Practice locations: Wichita, KS

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D0451899Hillside Medical Office855 N Hillside, Wichita, KS 67214ComplianceJan 20, 2027

National Provider Directory

National Provider Directory

Locations

855 N Hillside St
Wichita, KS 67214
Phone (316) 685-1381

885 N Hillside St
Wichita, KS 67214

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ECFFCD

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245283200000",
    "number": "1912969486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 N HILLSIDE ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672144913",
            "telephone_number": "316-685-1381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 N HILLSIDE ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672144913",
            "telephone_number": "316-685-1381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HILLSIDE MEDICAL OFFICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-03",
        "last_updated": "2009-06-18",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "316-685-1381",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "KS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS GROUP NUMBER",
            "identifier": "16399",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100087950A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2009; 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.