NPIMap

Organization Active NPI

Wilson County Hospital

  • Rural Health Clinic/Center
  • Independence, KS
National Provider Identifier
1003251802
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WILSON COUNTY HOSPITAL
Practice address
1415 N Penn Ave
Independence, KS 67301-2222
Phone
(620) 331-2400
Fax
(620) 331-0747
NPI assigned
May 7, 2013
Organization subpart
Yes
Parent organization
WILSON COUNTY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lori C Smith
Title
Cfo
Phone
(620) 325-8388

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1415 N Penn Ave
Independence, KS 67301-2222

Mailing address

PO Box 360
Neodesha, KS 66757-0360
Phone (620) 325-2611

Other identifiers 1

IdentifierTypeStateIssuer
012213OtherKSMEDICARE PART B PTAN

Other names 1

  • Independence Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041119000995 KS Part B Supplier - Clinic/Group Practice 0042273971 Receives reassigned benefits from 22 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cherryvale, KS; Independence, KS; Neodesha, KS
O20131003000610 KS Part A Provider - Rural Health Clinic 2163656208 Practice locations: Independence, KS

Rural health clinic certification: CCN 178582

Legal name
WILSON COUNTY HOSPITAL
Doing business as
INDEPENDENCE FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 16, 2014
Last certification
Feb 21, 2017
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
1415 N Penn Ave
Independence, KS 67301-2222
Related CCNs
171344

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D2058727Independence Family Medicine1415 N Penn Ave, Independence, KS 67301Certificate of waiverMay 9, 2027

National Provider Directory

National Provider Directory
Part of
Wilson County Hospital PC

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Wilson County Hospital Organization, Neodesha, KS Non-profit Operational/Managerial Control May 20, 2013
WM C Estes Individual Corporate OfficerBoard Officer Jun 1, 2013
Chris Tinsley Individual Corporate OfficerBoard Officer May 6, 2013
Drew Johnson Individual Corporate OfficerBoard Officer Feb 1, 2014
Lori C Smith Individual Operational/Managerial ControlCfo Nov 2, 2021
Carolyn M Caven Individual W-2 Managing EmployeePFS Director Nov 2, 2021
Amy Brown Individual Corporate OfficerBoard Officer May 6, 2013
Bert Chronister Individual Corporate OfficerBoard Officer May 6, 2013
Julie Lair Individual Corporate OfficerBoard Officer May 6, 2013
Michael Springer Individual Corporate OfficerBoard Officer Aug 1, 2015

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Cherryvale Family MedicineCherryvale, KS, CCN 178593 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2016
Oct 1, 1993

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727222400000",
    "number": "1003251802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 360",
            "city": "NEODESHA",
            "state": "KS",
            "postal_code": "667570360",
            "telephone_number": "620-325-2611",
            "fax_number": "620-325-8453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 N PENN AVE",
            "city": "INDEPENDENCE",
            "state": "KS",
            "postal_code": "673012222",
            "telephone_number": "620-331-2400",
            "fax_number": "620-331-0747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON COUNTY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILSON COUNTY HOSPITAL",
        "enumeration_date": "2013-05-07",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "620-325-8388"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B PTAN",
            "identifier": "012213",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Independence Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Independence, KS

Sources for this page

Verify at the official NPI Registry.