WICHITA SURGICAL SPECIALISTS PA – Surgery Physician, NPI 1154302180
Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for WICHITA SURGICAL SPECIALISTS PA
10090 E Shannon Woods Cir
Wichita, KS 672264107
Phone: (316) 684-2838
Type: Location
9350 E 35th St N Ste 103
Wichita, KS 672262022
Phone: (316) 858-5000
Fax: (316) 858-1026
Type: Location
700 W Central Ave Ste 202
El Dorado, KS 670422186
Phone: (800) 794-4368
Type: Location
1715 Medical Pkwy Ste 110B
Newton, KS 671148940
Phone: (800) 794-4368
Type: Location
3515 Broadway Ave
Great Bend, KS 675303633
Phone: (800) 794-4368
Type: Location
1305 E 5th Ave
Winfield, KS 671562406
Phone: (800) 794-4368
Type: Location
2600 Ottawa Rd
Neodesha, KS 667571897
Phone: (800) 794-4368
Type: Location
North Emporia Street, Wichita, Sedgwick County, Kansas, 67204-4502, United States
STE 200
WICHITA, KS 672143729
Phone: (316) 263-0296
Fax: (316) 263-9523
Type: Mailing
551 N HILLSIDE ST STE 201
WICHITA, KS 672144923
Phone: (316) 300-2571
Fax: (316) 263-9523
Type: Location
818 N Emporia St Ste 200
Wichita, KS 672143726
Phone: (316) 263-0296
Type: Location
3840 N Ridge Rd
Wichita, KS 672057815
Phone: (316) 722-5811
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-06-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-07-31 (675 days ago).
Enrollment records
1
Earliest due date
2024-07-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040616000735 | O | Clinic/Group Practice | KS | 2024-07-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 67226)
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