| Centerwell Senior Primary Care Ks Pa | |
|
16575 W 119th St Olathe KS 66061-7770 | |
| (913) 815-5508 | |
| (855) 446-7281 |
| Full Name | Centerwell Senior Primary Care Ks Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 16575 W 119th St, Olathe, Kansas |
| Authorized Official Name and Position | Angie Martinez (SENIOR CREDENTIALING PROFESSIONAL) |
| Authorized Official Contact | 4074477120 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centerwell Senior Primary Care Ks Pa 6101 Blue Lagoon Dr Ste 200 Miami FL 33126-3168 Ph: (305) 500-2000 | Centerwell Senior Primary Care Ks Pa 16575 W 119th St Olathe KS 66061-7770 Ph: (913) 815-5508 |
| NPI Number | 1013438654 |
|---|---|
| Provider Enumeration Date | 07/05/2017 |
| Last Update Date | 08/19/2024 |
| Medicare PECOS PAC ID | 6002230349 |
|---|---|
| Medicare Enrollment ID | O20200721000723 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013438654 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| Provider Name | Scott E Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093714933 PECOS PAC ID: 9739188152 Enrollment ID: I20070213000404 |
| Provider Name | Carol A Harrington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124018437 PECOS PAC ID: 4385647163 Enrollment ID: I20080421000182 |
| Provider Name | William Stueve |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225016462 PECOS PAC ID: 2466644893 Enrollment ID: I20101004001299 |
| Provider Name | Faisal Nazir Ahmad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912090879 PECOS PAC ID: 9537180922 Enrollment ID: I20101008001140 |
| Provider Name | Thuytien Le |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386984045 PECOS PAC ID: 2062650187 Enrollment ID: I20130531000485 |
| Provider Name | Marianne Cecille Ray |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457580060 PECOS PAC ID: 4486877313 Enrollment ID: I20140522001074 |
| Provider Name | Katherine D Easley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336547793 PECOS PAC ID: 6709100753 Enrollment ID: I20150121001973 |
| Provider Name | Stephanie M Ikeme |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790921914 PECOS PAC ID: 5395999767 Enrollment ID: I20190218000293 |
| Provider Name | Shanna Rose Ripley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184985921 PECOS PAC ID: 8123241270 Enrollment ID: I20210728002090 |
| Provider Name | Anthony Gutierrez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558368381 PECOS PAC ID: 6800910464 Enrollment ID: I20210824002965 |
| Provider Name | Anthonia Egbedeju |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568758829 PECOS PAC ID: 7719156934 Enrollment ID: I20211209000257 |
| Provider Name | Lauren Kay Rojas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578041125 PECOS PAC ID: 6709128390 Enrollment ID: I20220107001733 |
| Provider Name | Nancy Stepanek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861624843 PECOS PAC ID: 3476745746 Enrollment ID: I20220303000842 |
| Provider Name | Vinod Velakaturi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235124298 PECOS PAC ID: 7810025715 Enrollment ID: I20220413001734 |
| Provider Name | Sarah Doll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164969143 PECOS PAC ID: 4587949631 Enrollment ID: I20221102000456 |
| Provider Name | Sequita Richardson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356312458 PECOS PAC ID: 0749270213 Enrollment ID: I20230429000086 |
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