Minneola District Hospital NBR 2
Organization Active NPI Critical Access Hospital · Minneola, KS
NPI 1013009828 · NPPES record last updated Jun 8, 2015
Key facts
- NPI
- 1013009828
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- H013002 (KS)
- Legal business name
- MINNEOLA DISTRICT HOSPITAL NBR 2
- Practice address
- 212 Main Street
Minneola, KS 67865-8511 - Phone
- (620) 885-4264
- Fax
- (620) 885-4602
- NPI assigned
- Sep 29, 2006
- Organization subpart
- No
Authorized official
- Name
- Deborah Bruner
- Title
- Ceo
- Phone
- (620) 885-4264
Owners & managing parties with NPI records 4
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 3
Related certifications (CCN) 2
Practitioners 68
-
Mirza Ahmad, MD
-
Lauren A Amy, PAC
-
Trent Dylan Befort, APRN
-
Jonathan A Borchard, PAC
-
Peter Arthur Burgos, M.D.
-
Halie Davis, PA-C
-
David P. Demint Jr., CRNA
-
Rebecca Erb, PA
-
Kelly Bruce Gabel, D.O.
-
Jennifer Ann Imel, APRN
-
Matthew C Ridder, ARNP
-
Kent R Wagner, PA
-
Chance Williams, M.D.
-
Douglas L Best, MD
-
Tamara Carroll, M.D.
-
Elsie Haynes, D.O.
-
Hassan Massouh, M.D.
Affiliated clinicians 28
-
Mirza Ahmad, MD
-
Lauren A Amy, PAC
-
Jonathan A Borchard, PAC
-
Peter Arthur Burgos, M.D.
-
Halie Davis, PA-C
-
David P. Demint Jr., CRNA
-
Rebecca Erb, PA
-
Luis E Espinoza, MD
-
Kelly Bruce Gabel, D.O.
-
Jennifer Ann Imel, APRN
-
Shelly R Keesling, PA-C
-
Christopher D Miller, M.D.
-
Felecia Jean Minyard, APRN
-
James W Moffitt, MD
-
Matthew C Ridder, ARNP
-
Kent R Wagner, PA
-
Ryan Lee Weir, MD
-
Elsie Haynes, D.O.
Medicare Care Compare: Hospital
- Listed as
- Minneola District Hospital
- Type
- Critical Access Hospitals
- Ownership
- Government - Hospital District or Authority
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Hospital certification: CCN 171368
- Legal name
- MINNEOLA DISTRICT HOSPITAL NBR 2
- Doing business as
- MINNEOLA DISTRICT HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Feb 1, 2004
- Last certification
- Jul 10, 2018
- Beds
- 25
- Ownership / control type
- Hospital district or authority
- Organization structure
- Other · Non-profit
- Enrollment address
- 212 Main St
Minneola, KS 67865-8511
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Minneola District Hospital NBR 2 |
Other | Jun 24, 2015 | 100% |
| Dianna Beebe |
Corporate Director | Apr 5, 2011 | |
| Deborah a Bruner |
Corporate Director |
Oct 23, 2012 | |
| W-2 Managing Employee |
Oct 23, 2012 | ||
| Gail Norton |
Corporate Director | Apr 3, 2007 | |
| Jennifer Denison |
Corporate Director | Apr 5, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070223000124 | KS | Part a Provider - Critical Access Hospital | 1355252545 |
Receives reassigned benefits from 66 practitioners Practice locations: Minneola, KS |
National Provider Directory
- Tax ID family
- Minneola Dist Hosp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | H013002 | KS | Yes |
Addresses
Primary practice location
212 Main Street
Minneola, KS 67865-8511
Mailing address
Box 127
Minneola, KS 67865-0127
Phone (620) 885-4264
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100099190B | Medicaid | KS | |
| 014061 | Other | BLUE SHIELD (PC) | |
| 171368A000000 | Other | KS | UNDOCUMENTED ALIENS |
| 000185 | Other | KS | BLUE CROSS BLUE SHIELD |
| 100099190A | Medicaid | KS |
Other providers in Minneola, KS
- Jennifer Ann Imel
- JGS Health Services LLC
- Anthony D Luna
- Minneola District Hospital
- Minneola District Hospital
- Minneola District Hospital NBR 2
- Minneola District Hospital NBR 2
- Minneola Pharmacy II LLC
- Minneola Schools Usd# 219
- Nikki Lee Simmons
All providers in Minneola, KS · Critical Access Hospital in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2015. 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.