PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC
NPI 1356683213
General Practice in Shawnee, KS

Q: What is Prime Healthcare Physician Services - Providence Inc's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Active since March 19, 2013CLIA 17D0866647 · Waiver

16663 MIDLAND DR STE 100, SHAWNEE, KS 66217(913) 631-2600(913) 631-2606 Get Directions Write a Review

NPPES record last updated: August 25, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Prime Healthcare Physician Services - Providence Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC (NPI 1356683213), doing business as Providence Medical Group, is a healthcare organization registered as a general practice in Shawnee, Kansas and active in the NPI registry since March 2013. The organization holds a CLIA Waiver certificate valid through August 31, 2026, maintains 18 additional practice locations, and lists Christopher Doan, Managing Associate General Counsel, as its authorized official.

NPPES Registry Identity

NPI1356683213

Entity TypeOrganization

Primary Taxonomy208D00000X

Legal Business NamePRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC

Location Address16663 MIDLAND DR STE 100Shawnee, KS 66217-3042

Mailing Address8929 Parallel PkwyKansas City, KS 66112-1689 · (913) 596-3930 · Fax (913) 596-4098

Phone(913) 631-2600

Fax(913) 631-2606

Organization SubpartYesParent: Prime Healthcare Services, Inc

Authorized OfficialChristopher DoanManaging Associate General Counsel · (310) 259-4706

Enumeration DateMarch 19, 2013

Last NPPES UpdateAugust 25, 2025

NPPES CertifiedAugust 25, 2025

✔ NPI 1356683213 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 14

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

Also ListedOral & Maxillofacial SurgeryTaxonomy 204E00000X

Also ListedAnesthesiologyTaxonomy 207L00000X

Also ListedAnesthesiology · Pain MedicineTaxonomy 207LP2900X

Also ListedFamily MedicineTaxonomy 207Q00000X

Also ListedInternal MedicineTaxonomy 207R00000X

Also ListedInternal Medicine · Cardiovascular DiseaseTaxonomy 207RC0000X

Also ListedInternal Medicine · GastroenterologyTaxonomy 207RG0100X

Also ListedObstetrics & Gynecology · Urogynecology and Reconstructive Pelvic SurgeryTaxonomy 207VF0040X

Also ListedOrthopaedic SurgeryTaxonomy 207X00000X

Also ListedPreventive Medicine · Undersea and Hyperbaric MedicineTaxonomy 2083P0011X

Also ListedPsychiatry & Neurology · NeurologyTaxonomy 2084N0400X

Also ListedSurgeryTaxonomy 208600000X

Also ListedSurgery · Pediatric SurgeryTaxonomy 2086S0120X

16663 MIDLAND DR STE 100, Shawnee, KS 66217

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Other Names 1

Doing Business AsProvidence Medical Group

Secondary Practice Locations 18

Location 115604 Pinehurst Dr Ste 2Basehor, KS 66007-8234 · Phone (913) 728-2200

Location 23500 S 4th StLeavenworth, KS 66048-5043 · Phone (913) 680-6000

Location 33550 S 4th Street, Saint John Outpatient SurgeryLeavenworth, KS 66048 · Phone (913) 680-6000

Location 48919 Parallel Pkwy Ste 121Kansas City, KS 66112-1655 · Phone (913) 596-7230 · Fax (913) 596-7228

Location 58919 Parallel Pkwy Ste 416Kansas City, KS 66112-1655 · Phone (913) 596-5104

Location 68919 Parallel Pkwy Ste 555Kansas City, KS 66112-3628 · Phone (913) 596-3940 · Fax (913) 596-3730

Location 78919 Parallel Pkwy Ste 455Kansas City, KS 66112-3628 · Phone (913) 596-4929

Location 88919 Parallel Pkwy Ste 440Kansas City, KS 66112-1655 · Phone (913) 596-7286

Location 97255 Renner RdShawnee, KS 66217-3043 · Phone (913) 334-6800

Location 108919 Parallel Pkwy Ste 206Kansas City, KS 66112-1655 · Phone (913) 334-6800

Location 118101 Parallel Pkwy Ste 100Kansas City, KS 66112-2067 · Phone (913) 299-9200

Location 123550 S 4th St Ste 115Leavenworth, KS 66048-5061 · Phone (913) 596-7224

Location 138919 Parallel Pkwy Ste 580Kansas City, KS 66112-1655 · Phone (913) 596-7224

Location 14913 Sheidley AveBonner Springs, KS 66012-9514 · Phone (913) 322-7222

Location 153550 S 4th St Ste 200Leavenworth, KS 66048-5009 · Phone (913) 680-6442

Location 161420 S 42nd StKansas City, KS 66106-1952 · Phone (913) 831-1100

Location 177230 Renner RdShawnee, KS 66217-9901 · Phone (913) 962-2122 · Fax (913) 962-2422

Location 188929 Parallel PkwyKansas City, KS 66112-1689 · Phone (913) 596-3930 · Fax (913) 596-4098

Other Identifiers 2

Medicaid201193920HKS

Medicaid500017218MO

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter from Sunflower Health Plan, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 17D0866647

Prime Healthcare Services - Providence LLC · Kansas City, KS

Active · expires Aug 31, 2026

CLIA Number17D0866647

Laboratory TypeAncillary Testing Site In Health Care Center

Certificate Effective DateSeptember 1, 2024

Certificate Expiration DateAugust 31, 2026

Laboratory DirectorJames P. Mccullough MD

Laboratory Phone(913) 596-4711

Laboratory LocationPrime Healthcare Services - Providence LLC8929 Parallel Parkway, Kansas City, KS 66112

CLIA data matches this NPI record on: Address

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Prime Healthcare Physician Services - Providence Inc's NPI number?

The NPI number for Prime Healthcare Physician Services - Providence Inc is 1356683213. It was assigned to this organization in the NPPES registry on March 19, 2013. The provider is doing business as Providence Medical Group.

Where is Prime Healthcare Physician Services - Providence Inc located?

Prime Healthcare Physician Services - Providence Inc is located at 16663 Midland Dr Ste 100, Shawnee, KS 66217. The listed phone number is (913) 631-2600.

What is Prime Healthcare Physician Services - Providence Inc's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Does Prime Healthcare Physician Services - Providence Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 17D0866647) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Prime Healthcare Physician Services - Providence Inc accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and Ambetter of Oklahoma and 2 other insurers list Prime Healthcare Physician Services - Providence Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Prime Healthcare Physician Services - Providence Inc was last updated on August 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.