PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC
NPI 1356683213
General Practice in Shawnee, KS
NPI Status: Active since March 19, 2013
Contact Information
16663 MIDLAND DR STE 100
SHAWNEE, KS
ZIP 66217
Phone: (913) 631-2600
Fax: (913) 631-2606
- Organization
- General Practice
- Accepts Insurance
- CLIA Number: 17D0866647
- CLIA Cert. Type: Ancillary Testing Site in Health Care Center
- CLIA Exp. Date: 08-31-2026
About PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC
This page provides the complete NPI Profile along with additional information for Prime Healthcare Physician Services - Providence Inc, a primary care provider established in Shawnee, Kansas operating as a General Practice. The healthcare provider is registered in the NPI registry with number 1356683213 assigned on March 2013. The practitioner's primary taxonomy code is 208D00000X. The provider is registered as an organization and their NPI record was last updated one year ago. Prime Healthcare Physician Services - Providence Inc operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The provider's
- NPI
- 1356683213
- Provider Legal Name
- PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC
- Other Organization Name
- Other Name Type
- (6)
- Entity Type
- Organization
- Location Address
- 16663 MIDLAND DR STE 100 SHAWNEE, KS 66217
- Location Phone
- (913) 631-2600
- Location Fax
- (913) 631-2606
- Mailing Address
- 8929 PARALLEL PKWY KANSAS CITY, KS 66112
- Mailing Phone
- (913) 596-3930
- Mailing Fax
- (913) 631-2606
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 03-19-2013
- Last Update Date
- 08-25-2025
- Code Navigator
A primary care provider (PCP) like Prime Healthcare Physician Services - Providence Inc sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
Location Map
Secondary Locations
- 3550 S 4th Street Saint John Outpatient Surgery
Leavenworth, KS 66048
(913) 680-6000 - 3500 S 4th St
Leavenworth, KS 66048
(913) 680-6000 - 8919 Parallel Pkwy Ste 455
Kansas City, KS 66112
(913) 596-4929 - 7255 Renner Rd
Shawnee, KS 66217
(913) 334-6800 - 8919 Parallel Pkwy Ste 440
Kansas City, KS 66112
(913) 596-7286 - 8919 Parallel Pkwy Ste 206
Kansas City, KS 66112
(913) 334-6800 - 8919 Parallel Pkwy Ste 121
Kansas City, KS 66112
(913) 596-7230 - 8919 Parallel Pkwy Ste 416
Kansas City, KS 66112
(913) 596-5104 - 8919 Parallel Pkwy Ste 555
Kansas City, KS 66112
(913) 596-3940 - 1420 S 42nd St
Kansas City, KS 66106
(913) 831-1100 - 3550 S 4th St Ste 200
Leavenworth, KS 66048
(913) 680-6442 - 15604 Pinehurst Dr Ste 2
Basehor, KS 66007
(913) 728-2200 - 913 Sheidley Ave
Bonner Springs, KS 66012
(913) 322-7222 - 8919 Parallel Pkwy Ste 580
Kansas City, KS 66112
(913) 596-7224 - 3550 S 4th St Ste 115
Leavenworth, KS 66048
(913) 596-7224 - 8101 Parallel Pkwy Ste 100
Kansas City, KS 66112
(913) 299-9200 - 8929 Parallel Pkwy
Kansas City, KS 66112
(913) 596-3930 - 7230 Renner Rd
Shawnee, KS 66217
(913) 962-2122
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
General Practice
- Taxonomy Code
- 208D00000X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- 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
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 204E00000X | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery | |
| 2 | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | |
| 3 | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | |
| 4 | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
| 5 | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
| 6 | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
| 7 | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | |
| 8 | 207VF0040X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | |
| 9 | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | |
| 10 | 2083P0011X | Allopathic & Osteopathic Physicians | Preventive Medicine | |
| 11 | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | |
| 12 | 208600000X | Allopathic & Osteopathic Physicians | Surgery | |
| 13 | 2086S0120X | Allopathic & Osteopathic Physicians | Surgery |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Complete Silver - EPO
- Complete Silver + Vision + Adult Dental - EPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Everyday Gold - EPO
- Everyday Gold + Vision + Adult Dental - EPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Elite Gold - EPO
- Elite Gold + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Everyday Gold - EPO
- Everyday Gold + Vision + Adult Dental - EPO
- Focused Silver - EPO
- Focused Silver + Vision + Adult Dental - EPO
- Choice Bronze HSA - EPO
- Choice Bronze HSA + Vision + Adult Dental - EPO
- Clear Gold - EPO
- Clear Gold + Vision + Adult Dental - EPO
- Complete Gold - HMO
- Complete Gold + Vision + Adult Dental - HMO
- Elite Bronze - EPO
- Elite Bronze - HMO
- Elite Bronze + Vision + Adult Dental - EPO
- Elite Bronze + Vision + Adult Dental - HMO
- Clear Gold - EPO
- Clear Gold + Vision + Adult Dental - EPO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Elite Silver - EPO
- Elite Silver + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Focused Silver - EPO
- Focused Silver + Vision + Adult Dental - EPO
- Elite Bronze - PPO
- Elite Bronze + Vision + Adult Dental - PPO
- Elite Gold - PPO
- Elite Gold + Vision + Adult Dental - PPO
- Enhanced Asthma/COPD Care Silver with $0 Drug Options - PPO
- Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental - PPO
- Enhanced Diabetes Care Silver with $0 Drug Options - PPO
- Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - PPO
- Everyday Bronze - PPO
- Everyday Bronze + Vision + Adult Dental - PPO
- Anthem Bronze Pathway 10150 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Bronze Pathway 6900 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Bronze Pathway 7500 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Catastrophic Pathway (+ Incentives) - EPO
- Anthem Gold Pathway 2000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Heart Healthy Bronze Pathway 4900 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Heart Healthy Silver Pathway 3100 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Silver Pathway 5350 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Silver Pathway 6000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Silver Pathway 7200 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- BlueCare EPO Bronze - EPO
- BlueCare EPO Gold - EPO
- BlueCare EPO Gold Plus - EPO
- BlueCare EPO Silver Plus - EPO
- BlueCare EPO Simple Bronze HDHP - EPO
- BlueCare EPO Simple Silver HDHP - EPO
- BlueCare EPO Standardized Expanded Bronze - EPO
- BlueCare EPO Standardized Gold - EPO
- BlueCare EPO Standardized Silver - EPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 201193920H | MEDICAID (05) | KS | |
| 500017218 | MEDICAID (05) | MO |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 17D0866647
- Facility Type
- Ancillary Testing Site in Health Care Center
- Certificate Effective Date
- September 01, 2024
- Certificate Expiration Date
- August 31, 2026
- Laboratory Director
- JAMES P. MCCULLOUGH MD
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Prime Healthcare Physician Services - Providence Inc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1356683213, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 57. The final step is to find the difference between that total and the next multiple of ten (60 - 57 = 3).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 57 is 60. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1356683213, enumerated as an "organization" on March 19, 2013.
The provider is located at 16663 MIDLAND DR STE 100 SHAWNEE, KS 66217 and the phone number is (913) 631-2600.
General Practice with taxonomy code 208D00000X.
The provider might be accepting Accepts: Ambetter from Home State Health, Ambetter from. Please consult your insurance carrier or call the provider to verify.
