Amberwell Atchison Association
Organization Active NPI Rural Health Clinic/Center · Troy, KS
NPI 1104905033 · NPPES record last updated Nov 15, 2024
Key facts
- NPI
- 1104905033
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- AMBERWELL ATCHISON ASSOCIATION
- Practice address
- 311 W Locust St
Troy, KS 66087-5252 - Phone
- (785) 985-3504
- Fax
- (785) 985-3813
- NPI assigned
- Nov 2, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- AMBERWELL ATCHISON ASSOCIATION
Authorized official
- Name
- Jared Abel
- Title
- Ceo
- Phone
- (913) 367-2131
Owners & managing parties with NPI records 1
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 8
Practitioners 54
-
David W. Hart, DNP, CRNA
-
Joseph Asher, MD
-
Lucas Bauer, PA
-
Jennifer L Baum, PA
-
Gerald W Clevenger, PAC
-
Elizabeth Ann Courtney, FNP-BC
-
Brian Russell Duncan, M.D.
-
Andrew Durbin, CRNA
-
John Read Eplee, M.D.
-
Rachel Marie Frye, APRN
-
Abby Gentry, FNP-C
-
McGarrett Groth, DO
-
Katie Lynn Kettler, APRN, FNP-C
-
Douglas B Knox, M.D.
-
Johnathan K Leck, MD
-
Arlene Renee Long, FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D0699053 | Amberwell Troy Clinic | Certificate of waiver | Nov 9, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
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
- Corporation · Non-profit
- Enrollment address
- 311 W Locust St
Troy, KS 66087-5252
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Chase Dudzinski |
Corporate Officer |
Aug 1, 2022 | |
| Corporate Director |
Aug 1, 2022 | ||
| W-2 Managing Employee | Aug 1, 2022 | ||
| Taylor Hausmann |
Corporate Director |
Aug 1, 2025 | |
| Alicia Sorensen |
Corporate Officer |
Nov 1, 2019 | |
| Corporate Director |
Nov 1, 2019 | ||
| W-2 Managing Employee | Nov 1, 2019 | ||
| Lorin Affield |
Corporate Officer |
Sep 1, 2022 | |
| Corporate Director |
Jan 1, 2019 | ||
| Norma E Green |
Corporate Officer |
Jan 15, 2018 | |
| Corporate Director |
Feb 1, 2020 | ||
| W-2 Managing Employee | Jan 15, 2018 | ||
| Jordan Hawk |
Corporate Officer |
Mar 1, 2023 | |
| Corporate Director |
May 1, 2021 | ||
| Gerald Henry |
Corporate Officer |
Mar 1, 2023 | |
| Corporate Director |
Jan 1, 2019 | ||
| Kelli R McCarty |
W-2 Managing Employee |
Mar 31, 2014 | |
| Renee Nugent |
Corporate Officer |
Jan 1, 2026 | |
| Corporate Director |
Jan 1, 2026 | ||
| Stan Sluder |
Corporate Director |
Jan 1, 2025 | |
| Douglass Adair |
Corporate Director |
Jan 1, 2025 | |
| Jennifer Brockhoff |
W-2 Managing Employee |
Oct 1, 2022 | |
| Jared Abel |
Corporate Officer |
Jun 15, 2024 | |
| Corporate Director |
Jun 15, 2024 | ||
| W-2 Managing Employee | Jun 15, 2024 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Amberwell Hospice |
Hospice | Operational/Managerial Control | Jan 1, 2009 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030903000033 | KS | Part a Provider - Rural Health Clinic | 2466363858 | Practice locations: Troy, KS |
National Provider Directory
- Tax ID family
- Atchison Hosp
- Part of
- Atchison Hosp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100098780E | Medicaid | KS |
Other names
- Amberwell Troy Clinic
Other providers in Troy, KS
- Abundant Life Hospice Inc
- Thomas W Alderson
- City of Troy
- Gerald W Clevenger
- County of Doniphan
- County of Doniphan
- Dennis T. Myers D.D.S.,P.a.
All providers in Troy, KS · Rural Health Clinic/Center in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.