Miami County Medical Center Inc.
Organization Active NPI Rural Health Clinic/Center · Paola, KS
NPI 1164928347 · NPPES record last updated Apr 5, 2018
Key facts
- NPI
- 1164928347
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- MIAMI COUNTY MEDICAL CENTER INC.
- Practice address
- 1318 Kansas Dr
Paola, KS 66071-2107 - Phone
- (913) 557-5678
- Fax
- (913) 557-5681
- NPI assigned
- Apr 5, 2018
- Organization subpart
- Yes
- Parent organization (as reported)
- MIAMI COUNTY MEDICAL CENTER INC.
Authorized official
- Name
- Catherine R. Wiens
- Title
- VP/Quality & Compliance
- Phone
- (913) 791-4459
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 14
-
Talal W Khan, MD
-
Sherri S. Vaughn, MD
-
Akinlolu O Ojo, MBBS, PHD, MPH
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 3
Member of 1
Related certifications (CCN) 1
Change of ownership 1
Facilities with the same owner 25
Practitioners 26
-
Nicole E Avilez, PA-C
-
Paris M Brenn, FNP-C
-
Sara Jean Cobine, DO
-
Karolyn M. Cook, M.D.
-
Theodore R Cook, MD
-
Allison Edwards, MD
-
Osama M Ismael, M.D.
-
Alex R Johnson, MD
-
Ryan Kaub, CRNA
-
Michael J Malin, M.D.
-
Amy S McHenry, PA
-
Michael Ryan Rogers, DNAP
-
Sally Ann Sewell, CRNA
-
Mina Soleimani, M.D.
-
Taylor Elizabeth Westrom, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Rural health clinic certification: CCN 178611
- Legal name
- MIAMI COUNTY MEDICAL CENTER INC
- Doing business as
- OLATHE HEALTH FAMILY MEDICINE-PAOLA
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 20, 2009
- Last certification
- Mar 17, 2022
- Ownership / control type
- 1B
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 1318 Kansas Dr
Paola, KS 66071-2107 - Related CCNs
- 170049
All disclosed owners & managing parties 30
| Name | Role | Since | Share |
|---|---|---|---|
| Charles Jason Hannagan |
Corporate Officer |
Jul 16, 2019 | |
| W-2 Managing Employee |
Jul 16, 2019 | ||
| Elizabeth Carlton |
Corporate Director | Jan 1, 2023 | |
| Sally Maliski |
Corporate Director | Jan 1, 2023 | |
| Sherri L Vaughn |
Corporate Director | Jan 1, 2023 | |
| Monte Coffman |
Corporate Director | Jan 1, 2023 | |
| Debbie Wilkerson |
Corporate Director | Jan 1, 2023 | |
| Catherine R Wiens |
W-2 Managing Employee |
Jan 1, 2014 | |
| Talal W Khan |
Corporate Director | Jan 1, 2023 | |
| Janell Aust |
Corporate Director |
Jan 1, 2019 | |
| Jack a Newman |
Corporate Director | Jan 1, 2023 | |
| Elizabeth H King |
Corporate Director | Jan 1, 2023 | |
| Gregory Graves |
Corporate Director | Jan 1, 2023 | |
| Blake Heid |
Corporate Director |
Jan 1, 2019 | |
| Maureen Mahoney |
Corporate Director | Jan 1, 2023 | |
| Daniel Peters |
Corporate Officer | Jan 1, 2023 | |
| Corporate Director | Jan 1, 2023 | ||
| Douglas a Girod |
Corporate Director | Jan 1, 2023 | |
| Robba Moran |
Corporate Director | Jan 1, 2023 | |
| Kevin Lockett |
Corporate Director | Jan 1, 2023 | |
| David B Dillon |
Corporate Director | Jan 1, 2023 | |
| Brenda Dykstra |
Corporate Director | Jan 1, 2023 | |
| Douglas Gaston |
Corporate Director | Jan 1, 2023 | |
| Robert K Page |
Corporate Officer | Jan 1, 2023 | |
| Corporate Director | Jan 1, 2023 | ||
| Akinlolu O Ojo |
Corporate Director | Jan 1, 2023 | |
| Romano Delcore |
Corporate Director | Jan 1, 2023 | |
| Robert D Simari |
Corporate Director | Jan 1, 2023 | |
| Jeffery S. Dossett |
W-2 Managing Employee |
Jul 16, 2019 | |
| Paul Luce |
W-2 Managing Employee |
May 27, 2013 | |
| University of Kansas Hospital Authority |
5% Or Greater Direct Ownership Interest | Dec 5, 2023 | 100% |
| Jack Beal |
Corporate Director | Jan 1, 2023 | |
| Mark Uhlig |
Corporate Director | Jan 1, 2023 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Jun 1, 2018 | Change of Ownership |
Olathe Health Family Medicine-Paola |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180517002206 | KS | Part a Provider - Rural Health Clinic | 2163311457 | Practice locations: Paola, KS |
National Provider Directory
- Tax ID family
- Miami Co Medical Ctr Crna
- Part of
- Miami Co Medical Ctr Crna
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1318 Kansas Dr
Paola, KS 66071-2107
Mailing address
2100 Baptiste Dr
Paola, KS 66071-1314
Phone (913) 294-2327
Other names
- Olathe Health Family Medicine-Paola
Other providers in Paola, KS
- Stephen Robert Meirose
- Sandra D Meyer
- Miami County Health Department
- Miami County Medical Center Inc
- Miami County Medical Center Inc
- Miami County Medical Center Inc.
- Miami County Medical Center Inc.
- Miami County Surgical Associates LLC
- Mid-America Orthopedics KC LLC
- Mid-America Urology, PA
All providers in Paola, 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 Apr 5, 2018. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.