NPIMap

Organization Active NPI

Kiowa District Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Kiowa, KS
National Provider Identifier
1154314656
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
KIOWA DISTRICT HOSPITAL
Practice address
1002 S 4TH St
Kiowa, KS 67070-1825
Phone
(620) 825-4131
Fax
(620) 825-4667
NPI assigned
Aug 30, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

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

Authorized official

Name
Janell Lyn Goodno
Title
Cfo
Phone
(620) 825-4131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

1002 S 4TH St
Kiowa, KS 67070-1825

Mailing address

1002 S 4TH St
Kiowa, KS 67070-1825
Phone (620) 825-4131

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Kiowa.District@k-d-h.cernerdirect.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070228000715 KS Part A Provider - Critical Access Hospital 8325020670 Receives reassigned benefits from 2 practitioners
Practice locations: Kiowa, KS

Hospital certification: CCN 17Z331

Legal name
KIOWA DISTRICT HOSPITAL
Doing business as
KIOWA DISTRICT HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
1002 S 4TH St
Kiowa, KS 67070-1825
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Kiowa District Hospital PC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Janell L Goodno Individual 5% Or Greater Direct Ownership Interest Jan 1, 2018 5%
Corporate DirectorCfo Oct 1, 2012 5%
W-2 Managing EmployeeCfo Oct 1, 2012 5%
Operational/Managerial Control Jan 1, 2018 50%

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1154314656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 S 4TH ST",
            "city": "KIOWA",
            "state": "KS",
            "postal_code": "670701825",
            "telephone_number": "620-825-4131",
            "fax_number": "620-825-4667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 S 4TH ST",
            "city": "KIOWA",
            "state": "KS",
            "postal_code": "670701825",
            "telephone_number": "620-825-4131",
            "fax_number": "620-825-4667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIOWA DISTRICT HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-30",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "GOODNO",
        "authorized_official_first_name": "JANELL",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "620-825-4131"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Kiowa.District@k-d-h.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Hospital",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "1002 S 4th St",
            "city": "Kiowa",
            "state": "KS",
            "country_code": "US",
            "postal_code": "670701825",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kiowa, KS

Sources for this page

Verify at the official NPI Registry.