Add an Additional Location

KanCare Provider Enrollment and Changes: Providers must use the Kansas Modular Medicaid System (KMMS) Provider Enrollment Wizard to update their information for any or all of the Medicaid fee-for-service (FFS) and managed-care organization (MCOs) health plans.

Medicare or Ambetter Add a Location

Please only request additional addresses for display in the provider directory. Additional address are used for directory purposes only and are not needed for claims payment.

Sunflower will not process additional address requests for these practitioner types: emergency medicine, radiology, anesthesiology (excluding pain management), pathology, CRNA, midwives, occupational therapy, mid-levels not acting as a PCP holding a panel, and practitioners who practice exclusively in a facility setting.

Add for: * Ambetter (Health Insurance Marketplace) Medicare (Allwell / Wellcare)

Group/Facility Name *

Tax ID # *

Group NPI # *

Practitioner First Name

Practitioner Last Name

Practitioner NPI

Multiple Practitioners

If multiple practitioners adding this address as an additional location, please attach a spreadsheet with their names and NPI numbers

Additional Location Address

Street Address *

Address Line 2

City *

State *

ZIP / Postal Code *

Appointment Phone Number *

Location Phone Number *

Please enter your office hours below:

Comments

Update Requested By:

First Name *

Last Name *

Contact Email *

Contact Phone *