NPIMap

Organization Active NPI

Satanta District Hospital and Long-Term Care

  • Family Medicine Physician
  • Sublette, KS
National Provider Identifier
1073706255
Registry record updated Aug 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
HO41001 Issued in KS
Legal business name
SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE
Practice address
301 S Derby
Sublette, KS 67877-0398
Phone
(620) 675-2686
Fax
(620) 675-2236
NPI assigned
Aug 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2025

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

Authorized official

Name
Tina Pendergraft
Title
Administrator
Phone
(620) 649-2761

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X HO41001 KS Primary
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X

Addresses

Primary practice location

301 S Derby
Sublette, KS 67877-0398

Mailing address

PO Box 159
Satanta, KS 67870-0159
Phone (620) 675-2686

Other identifiers 2

IdentifierTypeStateIssuer
110229OtherKSMEDICARE NON RURAL HEALTH
110229OtherKSNON RURAL HEALTH NUMBER

Other names 1

  • Satanta District Hospital Clinic-Non Rural Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040311001369 KS Part B Supplier - Clinic/Group Practice 5991616054 Receives reassigned benefits from 15 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Elkhart, KS; Satanta, KS; Sublette, KS

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Satanta District Hospital6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/cbeeaf3b-295c-4ed3-bee9-82bd88557832/

Practitioners & affiliated clinicians

Practitioners 5

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": "1187740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756425600000",
    "number": "1073706255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 159",
            "city": "SATANTA",
            "state": "KS",
            "postal_code": "678700159",
            "telephone_number": "620-675-2686",
            "fax_number": "620-675-2236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S DERBY",
            "city": "SUBLETTE",
            "state": "KS",
            "postal_code": "678770398",
            "telephone_number": "620-675-2686",
            "fax_number": "620-675-2236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-22",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "status": "A",
        "authorized_official_last_name": "PENDERGRAFT",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "620-649-2761"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "HO41001",
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NON RURAL HEALTH",
            "identifier": "110229",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NON RURAL HEALTH NUMBER",
            "identifier": "110229",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Satanta District Hospital Clinic-Non Rural Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Satanta District Hospital Clinic-Non Rural Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sublette, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.