NPIMap

Organization Active NPI

Susan B. Allen Memorial Hospital

Doing business as SBA Medical Group - Hospitalist

  • Hospitalist Physician
  • El Dorado, KS
National Provider Identifier
1104349067
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
SUSAN B. ALLEN MEMORIAL HOSPITAL
Doing business as
SBA Medical Group - Hospitalist
Practice address
720 W Central Ave
El Dorado, KS 67042-2112
Phone
(316) 321-3300
NPI assigned
Jul 24, 2017
Last updated
May 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2024

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

Authorized official

Name
Melissa Hall
Title
Ceo
Phone
(316) 322-4558

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X NU Primary

Addresses

Primary practice location

720 W Central Ave
El Dorado, KS 67042-2112

Mailing address

720 W Central Ave
El Dorado, KS 67042-2112

Other names 1

  • SBA Medical Group - Hospitalist Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040324001452 KS Part B Supplier - Clinic/Group Practice 7719898980 Receives reassigned benefits from 53 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hillsboro, KS; El Dorado, KS; Augusta, KS

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Susan B Allen Hospital8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1500854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715817600000",
    "number": "1104349067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 W CENTRAL AVE",
            "city": "EL DORADO",
            "state": "KS",
            "postal_code": "670422112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 W CENTRAL AVE",
            "city": "EL DORADO",
            "state": "KS",
            "postal_code": "670422112",
            "telephone_number": "316-321-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN B. ALLEN MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-24",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "316-322-4558"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SBA Medical Group - Hospitalist",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SBA Medical Group - Hospitalist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Dorado, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; 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.