NPIMap

Organization Active NPI

Sheridan County Hospital

Doing business as Selden Community Clinic

  • Clinic/Center
  • Selden, KS
National Provider Identifier
1114033966
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SHERIDAN COUNTY HOSPITAL
Doing business as
Selden Community Clinic
Practice address
112 N. Kansas
Selden, KS 67757
Phone
(785) 386-4380
Fax
(785) 386-4380
NPI assigned
Aug 22, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Joseph A. Stratton
Title
Ceo/Administrator
Phone
(785) 675-3281

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

112 N. Kansas
Selden, KS 67757

Mailing address

826 18TH Street
Hoxie, KS 67740-0415
Phone (785) 675-3018

Other names 1

  • Selden Community Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160930000678 KS Part A Provider - Federally Qualified Health Center (FQHC) 7416842380 Practice locations: Selden, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114033966. Details of each certification follow.

Federally qualified health center certification: CCN 171868

Legal name
SHERIDAN COUNTY HOSPITAL
Doing business as
SELDEN COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 30, 2016
Last certification
Sep 30, 2016
Ownership / control type
For profit – partnership
Organization structure
OtherNon-profit
Enrollment address
112 N Kansas Ave
Selden, KS 67757-5971

Other NPIs with the same Medicare PAC ID 3

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
17D1065258Selden Community Clinic112 N Kansas, Selden, KS 67757Certificate of waiverFeb 25, 2027

National Provider Directory

National Provider Directory
Tax ID family
Hoxie Dental Clinic10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Rebecca Bird Individual W-2 Managing EmployeeCfo May 25, 2022
Deborah Wade Individual Corporate OfficerBoard Member Jun 21, 2017
Lester Keith Caldwell Individual Corporate OfficerBoard Member Aug 26, 2015
Chad Koster Individual Corporate OfficerCeo Feb 10, 2022
W-2 Managing Employee Feb 10, 2022
Lisa Schamberger Individual Corporate OfficerBoard Member Jun 21, 2017
Kou Lovin Individual Corporate Officer Jun 21, 2017
Mary Ellen Welshhon Individual Corporate OfficerBoard Member Jun 15, 2016
Erik Gaede Individual Corporate OfficerBoard Member Apr 28, 2022
Joy Bretz Individual Corporate OfficerBoard Member Jan 1, 2021
Reba White Individual Corporate OfficerBoard Member May 29, 2022
Sheridan County Hospital Organization, Hoxie, KS Operational/Managerial Control Jun 1, 2015 100%
Other Jun 1, 2015 100%
Lucille Heim Individual Corporate OfficerBoard Member Aug 26, 2015
Joe Welshhon Individual Corporate OfficerBoard Member Jun 15, 2016
Leanna Sloan Individual Corporate OfficerBoard Member Aug 26, 2015

Owners & managing parties with NPI records 3

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
Hoxie Medical ClinicHoxie, KS, CCN 171863 Federally qualified health center Other (100%) Jan 1, 1966

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 2

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": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114033966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 18TH STREET",
            "city": "HOXIE",
            "state": "KS",
            "postal_code": "677400415",
            "telephone_number": "785-675-3018",
            "fax_number": "785-675-2306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 N. KANSAS",
            "city": "SELDEN",
            "state": "KS",
            "postal_code": "67757",
            "telephone_number": "785-386-4380",
            "fax_number": "785-386-4380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHERIDAN COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STRATTON",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "785-675-3281"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Selden Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Selden, KS

Sources for this page

Verify at the official NPI Registry.