WICHITA NEPHROLOGY GROUP, PA (NPI# 1104877810) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104877810 |
| Entity Type | Organization |
| Organization Name | WICHITA NEPHROLOGY GROUP, PA |
| Practice Address |
818 N Emporia St Suite 310 Wichita KS 67214 |
| Mailing Address |
818 N Emporia St Suite 310 Wichita KS 67214-3729 |
| Practice Telephone | 3162635891 |
| Practice Fax Number | 3162633083 |
| Mailing Telephone | 3162635891 |
| Mailing Fax Number | 3162633083 |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2018-05-14 |
| Authorized Official Name | DR. USHASRI CHALLA (PHYSICIAN/OWNER) |
| Authorized Official Telephone | 3162635891 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100708900A | 05 | |
| KS | 100214570A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396238010 | Wichita Nephrology Group, Pa | Clinic/Center | 2122 N Garnett St, Wichita, KS 67206-3023 | 2018-06-07 |
| Street Address |
818 N EMPORIA ST SUITE 310 |
| City | WICHITA |
| State | KS |
| Zip Code | 67214 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033116835 | Duane L Osborne | Surgery | 818 N Emporia St, Suite 200, Wichita, KS 67214-3729 | 2005-07-07 |
| 1053727800 | Tracy D Smith | Nurse Practitioner | 818 N Emporia St, Suite 310, Wichita, KS 67214-3729 | 2014-07-01 |
| 1336401082 | Aaron Nilhas | Surgery | 818 N Emporia St, Suite 200, Wichita, KS 67214-3729 | 2012-06-08 |
| 1205164282 | Bernard T. Poole, Md, Pa | Orthopaedic Surgery | 818 N Emporia St, Suite 107, Wichita, KS 67214-3729 | 2009-12-02 |
| 1679704845 | Julianna M Bergkamp | Nurse Practitioner | 818 N Emporia St, Suite 403, Wichita, KS 67214-3729 | 2009-08-05 |
| 1609004316 | Amanda M Valliant | Internal Medicine | 818 N Emporia St, Suite 310, Wichita, KS 67214-3729 | 2009-07-01 |
| 1730320367 | Kathy Ornelas | Specialist/Technologist, Other | 818 N Emporia St, Suite 200, Wichita, KS 67214-3729 | 2009-03-11 |
| 1437316387 | Ronnie K Moussa | Internal Medicine | 818 N Emporia St, Suite 310, Wichita, KS 67214-3729 | 2008-05-19 |
| 1104025949 | Wissam Saliba | Internal Medicine | 818 N Emporia St, Wichita, KS 67214-3729 | 2007-07-12 |
| 1528263043 | Jeremy Deutsch | Internal Medicine | 818 N Emporia St, Suite 403, Wichita, KS 67214-3729 | 2007-06-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124591185 | Laquita Patrice Boyede | Durable Medical Equipment & Medical Supplies | 1503 Northeast Parkway, Wichita, KS 67214 | 2019-01-02 |
| 1891270674 | Kathryn Denise Boomer | Physician Assistant | 929 St. Francis N, Wichita, KS 67214 | 2018-09-27 |
| 1447756457 | Cardinal Health 132 LLC | Pharmacy | 527 N Grove Street, Suite 100, Wichita, KS 67214 | 2018-03-30 |
| 1023517174 | Laboratory Corporation of America Holdings | Clinical Medical Laboratory | 3243 E Murdock Street, Level G, Wichita, KS 67214 | 2018-02-05 |
| 1558887901 | Shonnetta Lachan Gabriel | Counselor | 2707 E. 21st St. N, Wichita, KS 67214 | 2017-08-17 |
| 1417492174 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 803 N Broadway Ave, Wichita, KS 67214 | 2017-01-04 |
| 1952850653 | Rachel J Johnson | Counselor | 805 N Volutsia, Wichita, KS 67214 | 2016-09-23 |
| 1063899813 | Christy Lee Foos | Social Worker | 2707 E. 21st St. North, Healthcore Clinic, Wichita, KS 67214 | 2015-04-30 |
| 1952708018 | William Schroeder Fargo | Specialist | 701 N. Emporia, Wichita, KS 67214 | 2014-12-04 |
| 1447692710 | Valeriya V Hunter | Dentist | 527 N Grove, Wichita, KS 67214 | 2013-07-26 |
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| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043404940 | Pierre J Souraty | Internal Medicine | 1035 North Emporia, Suite 105, Wichita, KS 67214-2998 | 2007-09-04 |
| 1306966965 | Matthew Todd Reed | Internal Medicine | 1035 N Emporia St Ste 105, Wichita, KS 67214-2943 | 2007-03-29 |
| 1548235575 | Paula S Pond | Internal Medicine | 1035 North Emporia, Suite 105, Wichita, KS 67214-2998 | 2006-02-22 |
| 1497734891 | Aisha Shaikh | Internal Medicine | 818 N Emporia St Ste 310, Wichita, KS 67214-3727 | 2006-01-13 |
| 1790198448 | Levi Curtis Short | Internal Medicine | 818 N Emporia St Ste 310, Wichita, KS 67214 | 2014-06-10 |
| 1922396894 | Joseph Meouchy | Internal Medicine | 818 N Emporia St Ste 310, Wichita, KS 67214-3727 | 2011-07-13 |
| 1609004316 | Amanda M Valliant | Internal Medicine | 818 N Emporia St, Suite 310, Wichita, KS 67214-3729 | 2009-07-01 |
| 1851513287 | Edgard Ibrahim Wehbe | Internal Medicine | 818 N Emporia St, Suite310, Wichita, KS 67214-3729 | 2007-05-03 |
| 1669425955 | Linda Lea Francisco | Internal Medicine | 818 N Emporia St, Suite 310, Wichita, KS 67214-3729 | 2006-05-18 |
| 1316990781 | Michael Edward Grant | Internal Medicine | 818 N Emporia St, Suite 310, Wichita, KS 67214-3729 | 2006-05-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.