NPIMap

Organization Active NPI

Adventhealth Ransom Memorial, Inc.

  • Rural Health Clinic/Center
  • Wellsville, KS
National Provider Identifier
1043773591
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ADVENTHEALTH RANSOM MEMORIAL, INC.
Practice address
424 Main St
Wellsville, KS 66092-8878
Phone
(785) 883-4863
NPI assigned
Apr 11, 2019
Last updated
Jun 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Authorized official

Name
Shawn Perry
Title
Cfo
Phone
(785) 229-8244

Specialties & licenses 1

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

Addresses

Primary practice location

424 Main St
Wellsville, KS 66092-8878

Mailing address

7315 E Frontage Rd Ste 202
Merriam, KS 66204-1658

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190503000317 KS Part A Provider - Rural Health Clinic 4486996907 Practice locations: Wellsville, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043773591. Details of each certification follow.

Rural health clinic certification: CCN 178590

Legal name
ADVENTHEALTH RANSOM MEMORIAL INC
Doing business as
ADVENTHEALTH WELLSVILLE HEALTH PARK
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 9, 2015
Last certification
Sep 10, 2024
Ownership / control type
2B
Most recent change of ownership
May 1, 2019 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
424 Main St
Wellsville, KS 66092-8878
Related CCNs
170014

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Adventhealth Ransom Mem Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Networks

  • devoted network organization-2b183dd2-4e80-4977-80a6-4fdf0df4361d

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Janet Peters Individual Corporate OfficerDirector / Vice Chair Apr 30, 2019
Corporate DirectorDirector / Vice Chair Apr 30, 2019
Shawn Perry Individual Contracted Managing EmployeeCfo Nov 27, 2023
Corporate OfficerCfo Nov 27, 2023
Operational/Managerial ControlCfo Nov 27, 2023
Jeffrey Graff Individual Corporate OfficerAssistant Secretary Apr 30, 2019
Brendan Johnson Individual Contracted Managing EmployeeCeo/President/Chair/Secretary Jan 20, 2025
Corporate OfficerCeo/President/Chair/Secretary Jan 20, 2025
Corporate DirectorCeo/President/Chair Jan 20, 2025
Operational/Managerial ControlCeo/President/Chair/Secretary Jan 20, 2025
Stuart Wolzen Individual Corporate DirectorDirector Apr 30, 2019
Adventisit Health Mid-America Inc Organization, Shawnee Mission, KS Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 19, 2018 100%
Ryan Henningson Individual Corporate DirectorDirector Apr 8, 2024
Sam Huenergardt Individual Corporate OfficerDirector/Chairperson Apr 30, 2019
Corporate DirectorDirector/Chairperson Jun 19, 2018
Michael Saunders Individual Corporate OfficerAssistant Secretary Apr 30, 2019
Adventist Health System Sunbelt Healthcare Corporation Organization, Altamonte Springs, FL Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Jun 19, 2018 100%
Ronald Carlson Individual Corporate DirectorDirector Apr 30, 2019
Kenneth J Frank Individual Corporate DirectorDirector Apr 30, 2019
William K Heinrich Individual Corporate OfficerDirector/Treasurer Sep 30, 2021
Corporate DirectorDirector/Treasurer Sep 30, 2021
Lynn Addiscott Individual Corporate OfficerAssistant Secretary Sep 13, 2018
John Coen Individual Corporate DirectorDirector Apr 30, 2019
Dallas Purkeypile Individual Corporate OfficerDirector/President May 1, 2020
Corporate DirectorDirector/President Feb 4, 2020
Adventist Health System Sunbelt Inc Organization, Altamonte Springs, FL Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 19, 2018 100%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 88

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

View all 88

Change-of-ownership history 1

DateEventCounterparty
May 1, 2019 Change of OwnershipThis provider was the buyer Wellsville Family Medical ClinicCCN 178590, KS, NPI 1053704734

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1043773591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7315 E FRONTAGE RD STE 202",
            "city": "MERRIAM",
            "state": "KS",
            "postal_code": "662041658",
            "fax_number": "913-676-2680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 MAIN ST",
            "city": "WELLSVILLE",
            "state": "KS",
            "postal_code": "660928878",
            "telephone_number": "785-883-4863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVENTHEALTH RANSOM MEMORIAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-11",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "PERRY",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "785-229-8244"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellsville, KS

Sources for this page

Verify at the official NPI Registry.