Pivotal Health & Wellness Inc
Organization Active NPI Home Health Agency · Courtland, KS
NPI 1003536871 · NPPES record last updated May 15, 2024
Key facts
- NPI
- 1003536871
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- PIVOTAL HEALTH & WELLNESS INC
- Practice address
- 314 Main St
Courtland, KS 66939-3024 - Phone
- (785) 955-0670
- NPI assigned
- Aug 31, 2022
- Organization subpart
- No
Authorized official
- Name
- Robin Lynn Carlson
- Title
- Coo
- Phone
- (785) 955-0670
Practitioners 3
-
Robin Carlson, CHW
-
Bethany A Wallin, DPT
-
Denise McClurg, CPTA
Affiliated clinicians 6
-
Ken H Baxa, DO
-
Nolan Jackson Beavers, M.D,
-
Craig Alan Concannon, M.D.
-
Kurtis William Klecan, M.D.
-
Timothy Blecha, MD
-
Julie A Theis, M.D.
Medicare Care Compare: Home health agency
- Listed as
- Pivotal Health & Wellness, Inc
- Ownership
- -
- Certified
- Apr 10, 2024
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Home health agency certification: CCN 178138
- Legal name
- PIVOTAL HEALTH & WELLNESS INC
- Doing business as
- PIVOTAL HEALTH & WELLNESS INC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Apr 10, 2024
- Last certification
- Apr 10, 2024
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 24, 2021 in KS
- Enrollment address
- 314 Main St
Courtland, KS 66939-3024
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Justin Hurley |
Corporate Director |
Aug 24, 2021 | |
| Neely Kohmetscher |
Corporate Director |
Aug 24, 2021 | |
| Bethany Wallin |
5% Or Greater Direct Ownership Interest |
Aug 24, 2021 | 51% |
| Corporate Director |
Aug 24, 2021 | 51% | |
| Robin Carlson |
5% Or Greater Direct Ownership Interest |
Aug 24, 2021 | 49% |
| Corporate Director |
Aug 24, 2021 | 49% | |
| Kori Field |
W-2 Managing Employee |
Oct 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230928002687 | KS | Part a Provider - Home Health Agency | 3375997042 | Practice locations: Courtland, KS |
National Provider Directory
Locations
314 Main St
Courtland, KS 66939
Phone (785) 955-0670
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes | ||
| Physical Therapy Clinic/Center | 261QP2000X |
Addresses
Primary practice location
314 Main St
Courtland, KS 66939-3024
Mailing address
314 Main St
Courtland, KS 66939-3024
Phone (785) 955-0670
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A-079-005 | Medicaid | KS |
Other providers in Courtland, KS
All providers in Courtland, KS · Home Health Agency in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.