NPIMap

Organization Active NPI

Susan B. Allen Memorial Hospital

  • General Practice Physician
  • El Dorado, KS
National Provider Identifier
1164554820
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
SUSAN B. ALLEN MEMORIAL HOSPITAL
Practice address
720 W Central Ave
El Dorado, KS 67042-2112
Phone
(316) 321-3300
Fax
(316) 321-2916
NPI assigned
Mar 9, 2007
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
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

720 W Central Ave
El Dorado, KS 67042-2112

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
014081OtherKSBCBS PART B
100002970EMedicaidKS

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
Practice locations: Hillsboro, KS; El Dorado, KS; Augusta, KS

Other NPIs with the same Medicare PAC ID 4

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

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

Locations

401 W 7th Ave
Ste 101
Augusta, KS 67010
Phone (316) 321-3300

720 W Central Ave
Ste 103
El Dorado, KS 67042

710 W Central Ave
El Dorado, KS 67042

Practitioners & affiliated clinicians

Practitioners 55

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

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715817600000",
    "number": "1164554820",
    "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": "720 W CENTRAL AVE",
            "city": "EL DORADO",
            "state": "KS",
            "postal_code": "670422112",
            "telephone_number": "316-321-3300",
            "fax_number": "316-321-2916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN B. ALLEN MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "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": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PART B",
            "identifier": "014081",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002970E",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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.