NPIMap

Organization Active NPI

Amberwell Atchison Association

Doing business as Amberwell Troy Clinic

  • Rural Health Clinic/Center
  • Troy, KS
National Provider Identifier
1104905033
Registry record updated Nov 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
AMBERWELL ATCHISON ASSOCIATION
Doing business as
Amberwell Troy Clinic
Practice address
311 W Locust St
Troy, KS 66087-5252
Phone
(785) 985-3504
Fax
(785) 985-3813
NPI assigned
Nov 2, 2006
Last updated
Nov 15, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
AMBERWELL ATCHISON ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 15, 2024

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

Authorized official

Name
Jared Abel
Title
Ceo
Phone
(913) 367-2131

Specialties & licenses 1

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

Addresses

Primary practice location

311 W Locust St
Troy, KS 66087-5252

Mailing address

800 Ravenhill Dr
Atchison, KS 66002-9204
Phone (913) 367-2131

Other names 1

  • Amberwell Troy Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030903000033 KS Part A Provider - Rural Health Clinic 2466363858 Practice locations: Troy, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104905033. Details of each certification follow.

Rural health clinic certification: CCN 173991

Legal name
AMBERWELL ATCHISON ASSOCIATION
Doing business as
AMBERWELL TROY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 1, 1992
Last certification
Mar 12, 2018
Ownership / control type
1B
Organization structure
CorporationNon-profit
Enrollment address
311 W Locust St
Troy, KS 66087-5252

Other NPIs with the same Medicare PAC ID 8

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
17D0699053Amberwell Troy Clinic311 W Locust, Troy, KS 66087Certificate of waiverNov 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Joseph L Kyner MD9 organizations share this tax ID, including this one
Part of
Joseph L Kyner MD

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Chase Dudzinski Individual Corporate OfficerCfo Aug 1, 2022
Corporate DirectorCfo Aug 1, 2022
W-2 Managing Employee Aug 1, 2022
Taylor Hausmann Individual Corporate DirectorBoard Member Aug 1, 2025
Alicia Sorensen Individual Corporate OfficerCoo/Cno Nov 1, 2019
Corporate DirectorCoo/Cno Nov 1, 2019
W-2 Managing Employee Nov 1, 2019
Lorin Affield Individual Corporate OfficerBoard Vice -Chairperson Sep 1, 2022
Corporate DirectorBoard Member Jan 1, 2019
Norma E Green Individual Corporate OfficerCmo Jan 15, 2018
Corporate DirectorRHC Medical Director/Cmo Feb 1, 2020
W-2 Managing Employee Jan 15, 2018
Jordan Hawk Individual Corporate OfficerBoard Secretary/Treasurer Mar 1, 2023
Corporate DirectorBoard Member May 1, 2021
Gerald Henry Individual Corporate OfficerBoard Chairperson Mar 1, 2023
Corporate DirectorBoard Member Jan 1, 2019
Kelli R McCarty Individual W-2 Managing EmployeeExec. Director of Revenue Cycle Mar 31, 2014
Renee Nugent Individual Corporate OfficerBoard Treasurer Jan 1, 2026
Corporate DirectorBoard Member Jan 1, 2026
Stan Sluder Individual Corporate DirectorBoard Member Jan 1, 2025
Douglass Adair Individual Corporate DirectorBoard Member Jan 1, 2025
Jennifer Brockhoff Individual W-2 Managing EmployeeExe. Director of Clinic Operations Oct 1, 2022
Jared Abel Individual Corporate OfficerCeo Jun 15, 2024
Corporate DirectorCeo Jun 15, 2024
W-2 Managing Employee Jun 15, 2024

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Amberwell HospiceAtchison, KS, CCN 171516 Hospice Operational/Managerial Control Jan 1, 2009

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

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": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731628800000",
    "number": "1104905033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 RAVENHILL DR",
            "city": "ATCHISON",
            "state": "KS",
            "postal_code": "660029204",
            "telephone_number": "913-367-2131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 W LOCUST ST",
            "city": "TROY",
            "state": "KS",
            "postal_code": "660875252",
            "telephone_number": "785-985-3504",
            "fax_number": "785-985-3813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMBERWELL ATCHISON ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMBERWELL ATCHISON ASSOCIATION",
        "enumeration_date": "2006-11-02",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A",
        "authorized_official_last_name": "ABEL",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "913-367-2131"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Amberwell Troy Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Troy, KS

Sources for this page

Verify at the official NPI Registry.