| Dodge City Family Care Clinic | |
|
2200 Summerlon Cir Ste A Dodge City KS 67801-2905 | |
| (620) 371-7300 | |
| (620) 371-7304 |
| Full Name | Dodge City Family Care Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 2200 Summerlon Cir Ste A, Dodge City, Kansas |
| Authorized Official Name and Position | Deborah Bruner (CEO) |
| Authorized Official Contact | 6208854264 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dodge City Family Care Clinic Po Box 127 Minneola KS 67865-0127 Ph: (620) 885-4264 | Dodge City Family Care Clinic 2200 Summerlon Cir Ste A Dodge City KS 67801-2905 Ph: (620) 371-7300 |
| NPI Number | 1376625749 |
|---|---|
| Provider Enumeration Date | 10/19/2006 |
| Last Update Date | 06/26/2025 |
| Certification Date | 06/26/2025 |
| Medicare PECOS PAC ID | 1355252545 |
|---|---|
| Medicare Enrollment ID | O20050302000745 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376625749 | NPI | - | NPPES |
| 000455 | Other | KS | BLUE CROSS RHC |
| 110486 | Other | KS | BLUE SHIELD |
| 100010520F | Medicaid | KS | |
| 100010520B | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 261QR1300X | Clinic/center - Rural Health | H013002 (Kansas) | Primary |
| Provider Name | Shawn L Conard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073511051 PECOS PAC ID: 3971406612 Enrollment ID: I20040129000778 |
| Provider Name | Jonathan a Borchard |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1578650834 PECOS PAC ID: 4486692993 Enrollment ID: I20050425000244 |
| Provider Name | Kent R Wagner |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1629062302 PECOS PAC ID: 7416996129 Enrollment ID: I20050502000475 |
| Provider Name | Samir K Shaath |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1023099686 PECOS PAC ID: 1850331265 Enrollment ID: I20050505000197 |
| Provider Name | Win M Kyi |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1720152952 PECOS PAC ID: 9133160880 Enrollment ID: I20050512000824 |
| Provider Name | Aye M Win |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1669521548 PECOS PAC ID: 6305887050 Enrollment ID: I20050512000829 |
| Provider Name | Matthew Charles Ridder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619082815 PECOS PAC ID: 1759325889 Enrollment ID: I20050620000200 |
| Provider Name | Mirza M Ahmad |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1942281506 PECOS PAC ID: 6305735937 Enrollment ID: I20050708000783 |
| Provider Name | Anthony D Luna |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659468924 PECOS PAC ID: 4284664251 Enrollment ID: I20050818000941 |
| Provider Name | Samuel T Stephens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164519427 PECOS PAC ID: 7416983085 Enrollment ID: I20060109000508 |
| Provider Name | Debra K Moffitt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386600781 PECOS PAC ID: 6305869041 Enrollment ID: I20060109001072 |
| Provider Name | Douglas L Best |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1659321438 PECOS PAC ID: 9234111675 Enrollment ID: I20070829000137 |
| Provider Name | Devamurugan Chandramohan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1235166620 PECOS PAC ID: 7810088747 Enrollment ID: I20071017000752 |
| Provider Name | James Moffitt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346205929 PECOS PAC ID: 0840109765 Enrollment ID: I20080131000630 |
| Provider Name | David Price Demint |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1437108750 PECOS PAC ID: 6103809348 Enrollment ID: I20080513000773 |
| Provider Name | Chance M Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902809775 PECOS PAC ID: 5597835652 Enrollment ID: I20090811000359 |
| Provider Name | Olufolajimi O Obembe |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1164630117 PECOS PAC ID: 7315097367 Enrollment ID: I20100702000339 |
| Provider Name | Matthew Sigley |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952347270 PECOS PAC ID: 4981872462 Enrollment ID: I20110728000243 |
| Provider Name | Patrick L Allen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023304508 PECOS PAC ID: 0648421180 Enrollment ID: I20121119000493 |
| Provider Name | Faris Azzouni |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1619110608 PECOS PAC ID: 9739345422 Enrollment ID: I20130916000115 |
| Provider Name | Kelly Gabel |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1538307236 PECOS PAC ID: 1153555164 Enrollment ID: I20131007000741 |
| Provider Name | Lauren a Amy |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1720412851 PECOS PAC ID: 0345475810 Enrollment ID: I20131109000241 |
| Provider Name | Jose L Renteria |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053704361 PECOS PAC ID: 1951629963 Enrollment ID: I20150422001832 |
| Provider Name | Daryl Pinedo |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1609098110 PECOS PAC ID: 3577719673 Enrollment ID: I20160415000463 |
| Provider Name | Nathan David Schandevel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699162149 PECOS PAC ID: 9638474612 Enrollment ID: I20181017001204 |
| Provider Name | Peter a Burgos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154767655 PECOS PAC ID: 9830428465 Enrollment ID: I20190907000186 |
| Provider Name | Ross Binford |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1063056752 PECOS PAC ID: 9537598750 Enrollment ID: I20200408003788 |
| Provider Name | Brandon Stroh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841293628 PECOS PAC ID: 8224073838 Enrollment ID: I20200731002362 |
| Provider Name | Jennifer Ann Imel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437775574 PECOS PAC ID: 1951714583 Enrollment ID: I20201228002581 |
| Provider Name | Trent Befort |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427655414 PECOS PAC ID: 3577963990 Enrollment ID: I20210607001752 |
| Provider Name | Ryan L Weir |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285127696 PECOS PAC ID: 9234485855 Enrollment ID: I20210812002661 |
| Provider Name | Kati R Mahalek |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1982096996 PECOS PAC ID: 0941521793 Enrollment ID: I20210812003891 |
| Provider Name | Anna R Cleland-leighton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891280186 PECOS PAC ID: 2264781988 Enrollment ID: I20210923001400 |
| Provider Name | Rebecca Erb |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1992372338 PECOS PAC ID: 9638569320 Enrollment ID: I20211213001655 |
| Provider Name | David Mcnaul |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1144262668 PECOS PAC ID: 2163318189 Enrollment ID: I20220207001203 |
| Provider Name | Claire Suzanne Moffitt |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1174198741 PECOS PAC ID: 9234511890 Enrollment ID: I20220729001495 |
| Provider Name | Jessica Bradford |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1699411892 PECOS PAC ID: 1153797725 Enrollment ID: I20221024000171 |
| Provider Name | Peter J Frank |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1871056697 PECOS PAC ID: 0840674875 Enrollment ID: I20230828003748 |
| Provider Name | Timothy Hanson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1801852173 PECOS PAC ID: 0648379305 Enrollment ID: I20230927002996 |
| Provider Name | Joseph Letham |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720583024 PECOS PAC ID: 7214396555 Enrollment ID: I20231103000390 |
| Provider Name | John MD Waddell |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1629562582 PECOS PAC ID: 1355699075 Enrollment ID: I20240615000448 |
| Provider Name | Elsie Haynes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538519384 PECOS PAC ID: 1759629066 Enrollment ID: I20240713000377 |
| Provider Name | Artur Narkiewicz Jodko |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1104188879 PECOS PAC ID: 3678846011 Enrollment ID: I20240903002209 |
| Provider Name | Benjamin Yunk |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1982100038 PECOS PAC ID: 8729448766 Enrollment ID: I20240904001320 |
| Provider Name | Bradford Scott Bennett |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1609308105 PECOS PAC ID: 6709134083 Enrollment ID: I20240904003075 |
| Provider Name | Steven Larsen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1508953555 PECOS PAC ID: 7517965064 Enrollment ID: I20240904003139 |
| Provider Name | Jonathan Samuel Mcdougal |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1255866224 PECOS PAC ID: 3375812050 Enrollment ID: I20240914000487 |
| Provider Name | Moayad Tarboush |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841668308 PECOS PAC ID: 6800187196 Enrollment ID: I20240914000498 |
| Provider Name | Gautham R Kandukuri |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1174979462 PECOS PAC ID: 5890086680 Enrollment ID: I20240914000669 |
| Provider Name | Mark Epstein |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1730525742 PECOS PAC ID: 9638433857 Enrollment ID: I20241022001744 |
| Provider Name | Derik Kenneth Kenworthy |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861726077 PECOS PAC ID: 5193852077 Enrollment ID: I20241104001444 |
| Provider Name | Kimberly Wright |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1356488605 PECOS PAC ID: 8123159308 Enrollment ID: I20241115000256 |
| Provider Name | Hassan Massouh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083723969 PECOS PAC ID: 6305815820 Enrollment ID: I20241216000972 |
| Provider Name | Tamara Carroll |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1467741538 PECOS PAC ID: 5698093169 Enrollment ID: I20250213003469 |
| Provider Name | David M Cameron |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1386610442 PECOS PAC ID: 1658300082 Enrollment ID: I20250331000894 |
| Provider Name | Bryon Scott Ward |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1336467430 PECOS PAC ID: 3678766383 Enrollment ID: I20250918004533 |
| Provider Name | Halie N Davis |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1962382556 PECOS PAC ID: 5496245060 Enrollment ID: I20251104000321 |
| Provider Name | Delbert a Benzenhafer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1750744819 PECOS PAC ID: 0446542286 Enrollment ID: I20260218000793 |
| Provider Name | Gene Weinstein |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114213881 PECOS PAC ID: 2365741196 Enrollment ID: I20260225002554 |
| Provider Name | Aaron Benner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1740408384 PECOS PAC ID: 3577632033 Enrollment ID: I20260226001269 |
| Provider Name | Jonathan Larson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639516503 PECOS PAC ID: 6608165527 Enrollment ID: I20260423002462 |
Genesis Family Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1700 Avenue F, Dodge City, KS 67801 Phone: 620-227-9797 Fax: 620-227-9751 |
Commonspirit Internal Medicine Dodge City Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2300 N 14th Ave Ste 104, Dodge City, KS 67801 Phone: 620-371-7010 Fax: 620-371-7011 |
Commonspirit Family Practice Dodge City Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 W Ross Blvd Ste 1b, Dodge City, KS 67801 Phone: 620-371-5576 Fax: 620-371-5006 |
C&s Medical Clinic PA Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2200 Summerlon Circle, Suite A, Dodge City, KS 67801 Phone: 620-408-9700 Fax: 620-408-9701 |
Genesis Family Health Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 100 Military Ave Ste 121b, Dodge City, KS 67801 Phone: 620-225-6821 |
Hodgeman County Medical Services, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2200 Summerlon Cir, Ste A, Dodge City, KS 67801 Phone: 620-408-9700 Fax: 620-408-9701 |