NPIMap

Organization Active NPI

Community Health Center of Southeast Kansas, Inc.

  • Federally Qualified Health Center (FQHC)
  • Pleasanton, KS
National Provider Identifier
1063997377
Registry record updated Oct 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
Practice address
11155 Tucker Rd
Pleasanton, KS 66075-8401
Phone
(620) 231-9873
NPI assigned
Oct 2, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2018

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

Authorized official

Name
Daniel Spencer Creitz
Title
General Counsel
Phone
(620) 240-5015

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

11155 Tucker Rd
Pleasanton, KS 66075-8401

Mailing address

3011 N Michigan St
Pittsburg, KS 66762-2546
Phone (620) 231-9873

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040209000163 KS Part B Supplier - Clinic/Group Practice 7911816392 Receives reassigned benefits from 184 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Parsons, KS; Pleasanton, KS; Pittsburg, KS; Mound City, KS; La Cygne, KS; Iola, KS; Independence, KS; Garnett, KS…
O20181215000302 KS Part A Provider - Federally Qualified Health Center (FQHC) 7911816392 Practice locations: Pleasanton, KS

Federally qualified health center certification: CCN 171885

Legal name
COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS INC
Doing business as
COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS/PLEASANTON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 14, 2018
Last certification
Dec 14, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 20, 2001 in KS
Enrollment address
11155 Tucker Rd
Pleasanton, KS 66075-8401

Other NPIs on the same Medicare enrollment 23

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

View all 23

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center of Southeast Kanas Inc43 organizations share this tax ID, including this one

Other organizations with this tax ID 42

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

View all 42

Locations

11155 Tucker Rd
#340B565100
Pleasanton, KS 66075

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Janie Henderson Individual Corporate Director Dec 31, 2018 100%
Krista Kay Postai Individual Corporate Officer Dec 31, 2018 100%
W-2 Managing Employee Dec 31, 2018 100%
Operational/Managerial Control Dec 31, 2018 100%
Judy a. Westhoff Individual Corporate Director Dec 31, 2018 100%
Monica C. Laforte Individual Corporate Director Dec 31, 2018 100%
Brian Jones Individual Corporate Director Dec 31, 2018 100%
Dawn Flores Individual Corporate Director Dec 31, 2018 100%
John Wyrick Individual Corporate Director Dec 31, 2018 100%
Rosaura Lopez Individual Corporate Director Dec 31, 2018 100%
Community Health Center of Southeast Kansas Inc Organization, Pleasanton, KS Operational/Managerial Control Dec 31, 2018 100%
Betha K Elliott Individual Corporate Director Dec 31, 2018 100%
Theresa Harris Individual Corporate Director Dec 31, 2018 100%
Patrick O'Bryan Individual Corporate Director Dec 31, 2018 100%

All facility ownership & control disclosures 18

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

FacilityTypeRoleSince
Community Health Center of Southeast Kansas IncCoffeyville, KS, CCN 171840 Federally qualified health center Operational/Managerial Control (100%) Nov 15, 2011
Community Health Center of Southeast Kansas/CoffeyvilleCoffeyville, KS, CCN 171842 Federally qualified health center Operational/Managerial Control (100%) Jan 2, 2012
Community Health Center of Southeast Kansas/IolaIola, KS, CCN 171846 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2008
CHC/Sek'S Field Kindley Student Health CenterCoffeyville, KS, CCN 171849 Federally qualified health center Operational/Managerial Control Oct 15, 2013
Community Health Center of Southeast Kansas IncIndependence, KS, CCN 171850 Federally qualified health center Operational/Managerial Control (100%) Jun 2, 2014
Community Health Center of Southeast Kansas/ParsonsParsons, KS, CCN 171861 Federally qualified health center Operational/Managerial Control (100%) Aug 31, 2015
CHC/Sek Arma ClinicArma, KS, CCN 171886 Federally qualified health center Operational/Managerial Control (100%) Dec 31, 2018
Community Health Center of Southeast Kansas Inc/Fort Scott Main ClinicFort Scott, KS, CCN 171887 Federally qualified health center Operational/Managerial Control (100%) Dec 31, 2018
Community Health Center of Southeast Kansas/Mound CityMound City, KS, CCN 171889 Federally qualified health center Operational/Managerial Control (100%) Dec 31, 2018
CHC/Ok Miami ClinicMiami, OK, CCN 371945 Federally qualified health center Operational/Managerial Control Nov 20, 2019
Community Health Center of Southeast Kansas IncPittsburg, KS, CCN 171891 Federally qualified health center Operational/Managerial Control Oct 17, 2018
CHC/Sek South PittsburgPittsburg, KS, CCN 171895 Federally qualified health center Operational/Managerial Control Apr 17, 2020
Community Health Center of Southeast Kansas IncLa Cygne, KS, CCN 171905 Federally qualified health center Operational/Managerial Control (100%) Sep 24, 2021
Community Health Center of Southeast Kansas IncColumbus, KS, CCN 171017 Federally qualified health center Operational/Managerial Control (100%) Nov 7, 2022
Community Health Center of Southeast Kansas IncBaxter Springs, KS, CCN 171018 Federally qualified health center Operational/Managerial Control (100%) Feb 1, 2023
Community Health Center of Southeast Kansas IncIola, KS, CCN 171019 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2023
Community Health Center of Southeast Kansas IncPittsburg, KS, CCN 171024 Federally qualified health center Operational/Managerial Control Aug 1, 2023
Community Health Center of Southeast Kansas IncHumboldt, KS, CCN 171026 Federally qualified health center Operational/Managerial Control Apr 1, 2024

Facilities with the same owner 18

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

View all 18

Practitioners & affiliated clinicians

Practitioners 4

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": "1538438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538438400000",
    "number": "1063997377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3011 N MICHIGAN ST",
            "city": "PITTSBURG",
            "state": "KS",
            "postal_code": "667622546",
            "telephone_number": "620-231-9873",
            "fax_number": "620-231-5062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11155 TUCKER RD",
            "city": "PLEASANTON",
            "state": "KS",
            "postal_code": "660758401",
            "telephone_number": "620-231-9873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-02",
        "last_updated": "2018-10-02",
        "status": "A",
        "authorized_official_last_name": "CREITZ",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "SPENCER",
        "authorized_official_title_or_position": "GENERAL COUNSEL",
        "authorized_official_telephone_number": "620-240-5015"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasanton, KS

Sources for this page

Verify at the official NPI Registry.