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FORM ASSOCIATES, P.A.
NPI 1740971605
Internal Medicine - Endocrinology, Diabetes & Metabolism in Wichita, KS

Active since May 19, 2023
801 E DOUGLAS AVE FL 2, WICHITA, KS 67202(617) 505-1520(617) 928-8401 Get Directions Write a Review

NPPES record last updated: March 18, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 18, 2026, May 19, 2023 (2 updates tracked since 2023).

About Form Associates, P.a. NPPES

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

FORM ASSOCIATES, P.A. (NPI 1740971605) is a healthcare organization registered as an endocrinology, diabetes & metabolism in Wichita, Kansas and active in the NPI registry since May 2023. The organization lists Troy Russell, Owner, as its authorized official.

NPPES Registry Identity

NPI1740971605
Entity TypeOrganization
Primary Taxonomy207RE0101X
Legal Business NameFORM ASSOCIATES, P.A.
Location Address801 E DOUGLAS AVE FL 2Wichita, KS 67202-3548
Mailing Address109 State St., 5th FlBoston, MA 02109-2906 · (617) 505-1520 · Fax (617) 928-8401
Phone(617) 505-1520
Fax(617) 928-8401
Organization SubpartNo
Authorized OfficialTroy RussellOwner · (617) 505-1520
Enumeration DateMay 19, 2023
Last NPPES UpdateMarch 18, 20262 updates tracked since enumeration
NPPES CertifiedMarch 18, 2026
✔ NPI 1740971605 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal Medicine · Endocrinology, Diabetes & MetabolismAllopathic & Osteopathic Physicians
Taxonomy Code207RE0101X
Definition
An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedClinic/Center · Health ServiceTaxonomy 261QH0100X
801 E DOUGLAS AVE FL 2, Wichita, KS 67202
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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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Form Associates, P.a. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to Form Associates, P.A., which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (6)

Rebecca Popp, APRN
Nurse Practitioner
NPI 1255987079
801 E DOUGLAS AVE FL 2
Wichita, KS 67202
(617) 505-1520
✔ PECOSSame address
Kristen Hamm, MSN, AGPCNP-BC APNP
Nurse Practitioner
NPI 1902215247
801 E DOUGLAS AVE FL 2
Wichita, KS 67202
(617) 505-1520
✔ PECOS✔ Accepts MedicareSame address
Dominique Kalil, MD
Internal Medicine
NPI 1336386218
325 N SAINT PAUL ST STE 3100
Dallas, TX 75201
(617) 505-1520
✔ PECOS329 mi
Charles Kim, MD
Family Practice
NPI 1700854411
325 N SAINT PAUL ST STE 3100
Dallas, TX 75201
(617) 505-1520
✔ PECOS✔ Accepts Medicare329 mi
Sangita Pogge, M.D.
Internal Medicine
NPI 1407174774
325 N SAINT PAUL ST STE 3100
Dallas, TX 75201
(617) 505-1520
✔ PECOS329 mi
Emilija Rosenthal, NP
Nurse Practitioner
NPI 1710485479
325 N SAINT PAUL ST STE 3100
Dallas, TX 75201
(617) 505-1520
✔ PECOS329 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Form Associates, P.A.'s NPI number?

The NPI number for Form Associates, P.A. is 1740971605. It was assigned to this organization in the NPPES registry on May 19, 2023.

Where is Form Associates, P.A. located?

Form Associates, P.A. is located at 801 E Douglas Ave Fl 2, Wichita, KS 67202. The listed phone number is (617) 505-1520.

What is Form Associates, P.A.'s specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Endocrinology, Diabetes & Metabolism, with taxonomy code 207RE0101X.

Is Form Associates, P.A. enrolled in Medicare?

Yes. Form Associates, P.A. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Form Associates, P.A.?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 3 Medicare specialties reassign their Medicare billing to Form Associates, P.A.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (3), Internal Medicine (2) and Family Practice (1). Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Form Associates, P.A. was last updated on March 18, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.