NPIMap

Organization Active NPI

Susan B. Allen Memorial Hospital

Doing business as SBA Medical Group

  • Emergency Medical Services (Emergency Medicine) Physician
  • El Dorado, KS
National Provider Identifier
1124594957
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
Legal business name
SUSAN B. ALLEN MEMORIAL HOSPITAL
Doing business as
SBA Medical Group
Practice address
700 W Central Ave Ste 103
El Dorado, KS 67042-2187
Phone
(316) 321-8751
Fax
(316) 321-8752
NPI assigned
Oct 19, 2018
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
Emergency Medical Services (Emergency Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207PE0004X Primary

Addresses

Primary practice location

700 W Central Ave Ste 103
El Dorado, KS 67042-2187

Mailing address

720 W Central Ave
El Dorado, KS 67042-2112
Phone (316) 321-3300

Other names 1

  • SBA Medical Group 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 Memorial Hosp8 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.

Locations

401 W 7th Ave
Augusta, KS 67010
Phone (316) 558-5575

401 W 7th Ave
Ste 102
Augusta, KS 67010
Phone (316) 558-8668

2710 W Central Ave
El Dorado, KS 67042
Phone (316) 452-5860

700 W Central Ave
Ste 102
El Dorado, KS 67042
Phone (316) 321-8739

700 W Central Ave
Ste 108
El Dorado, KS 67042
Phone (316) 321-7550

700 W Central Ave
Ste 204
El Dorado, KS 67042
Phone (316) 320-0501

701 W Central Ave
El Dorado, KS 67042
Phone (316) 321-1368

100 Industrial Rd
Hillsboro, KS 67063
Phone (620) 947-3114

Practitioners & affiliated clinicians

Practitioners 44

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.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1539907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715817600000",
    "number": "1124594957",
    "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",
            "telephone_number": "316-321-3300",
            "fax_number": "316-321-4810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W CENTRAL AVE STE 103",
            "city": "EL DORADO",
            "state": "KS",
            "postal_code": "670422187",
            "telephone_number": "316-321-8751",
            "fax_number": "316-321-8752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN B. ALLEN MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-19",
        "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": "207PE0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SBA Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SBA Medical Group",
            "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.