NPIMap

Organization Active NPI

Decatur Health Systems Inc

Doing business as Decatur Health Systems Family Practice Clinic

  • Rural Health Clinic/Center
  • Oberlin, KS
National Provider Identifier
1013222629
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DECATUR HEALTH SYSTEMS INC
Doing business as
Decatur Health Systems Family Practice Clinic
Practice address
902 W Columbia St
Oberlin, KS 67749-2412
Phone
(785) 475-2015
Fax
(785) 475-3847
NPI assigned
Aug 9, 2010
Last updated
Sep 20, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
DECATUR HEALTH SYSTEMS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

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

Authorized official

Name
Ms. Julie Smith
Title
Ceo
Phone
(785) 475-2208

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X KS Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

902 W Columbia St
Oberlin, KS 67749-2412

Mailing address

PO Box 268
Oberlin, KS 67749-0268
Phone (785) 475-2208

Other names 1

  • Decatur Health Systems Family Practice Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101007000129 KS Part B Supplier - Clinic/Group Practice 8022928225 Receives reassigned benefits from 24 practitioners
Practice locations: Oberlin, KS
O20110427000614 KS Part A Provider - Rural Health Clinic 8022928225 Practice locations: Oberlin, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013222629. Details of each certification follow.

Rural health clinic certification: CCN 178564

Legal name
DECATUR HEALTH SYSTEMS INC
Doing business as
DECATUR HEALTH SYSTEMS FAMILY PRACTICE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 26, 2011
Last certification
Oct 31, 2013
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 10, 2002 in KS
Enrollment address
902 W Columbia St
Oberlin, KS 67749-2412
Related CCNs
171352

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

Other NPIs with the same Medicare PAC ID 2

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

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
17D2137037Family Practice Clinic902 W Columbia Street, Oberlin, KS 67749Certificate of waiverSep 18, 2027

National Provider Directory

National Provider Directory
Part of
Cedar Living Center

Locations

920 W Columbia St
Oberlin, KS 67749

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Julie Smith Individual Corporate OfficerCeo May 29, 2022
W-2 Managing EmployeeCeo Jul 27, 2021
Operational/Managerial ControlCeo Jul 27, 2021
Regan Nicole May Individual Corporate Officer Jan 27, 2025
Corporate Director Jan 1, 2023
Jan Badsky Individual Corporate Officer Mar 30, 2017
Corporate Director Mar 18, 2015
Chad Meyer Individual W-2 Managing EmployeeCfo Apr 13, 2020
Operational/Managerial ControlCfo Apr 13, 2020
Audry Soderlund Individual W-2 Managing EmployeeBusiness Office Manager Mar 13, 2020
Operational/Managerial ControlBusiness Office Manager Mar 13, 2020
Tyler Roe Individual Corporate Officer Jan 16, 2023
Corporate Director Sep 20, 2021
Craig D Bartruff Individual W-2 Managing EmployeeMD; Feb 21, 2017
Operational/Managerial ControlMedical Director Feb 21, 2017
Cynthia a Haynes Individual Corporate Director Jan 1, 2025
Jordan-Lee W Stephenson Individual W-2 Managing EmployeeAd;Director of Clinic Operations Feb 17, 2023
Operational/Managerial ControlDirector of Clinic Operations Feb 17, 2023

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1281312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663632000000",
    "number": "1013222629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 268",
            "city": "OBERLIN",
            "state": "KS",
            "postal_code": "677490268",
            "telephone_number": "785-475-2208",
            "fax_number": "785-475-2453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 W COLUMBIA ST",
            "city": "OBERLIN",
            "state": "KS",
            "postal_code": "677492412",
            "telephone_number": "785-475-2015",
            "fax_number": "785-475-3847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECATUR HEALTH SYSTEMS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DECATUR HEALTH SYSTEMS INC",
        "enumeration_date": "2010-08-09",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "785-475-2208",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KS",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Decatur Health Systems Family Practice Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Decatur Health Systems Family Practice Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oberlin, KS

Sources for this page

Verify at the official NPI Registry.