NPIMap

Organization Active NPI

Miami County Medical Center Inc.

Doing business as Family Medicine, Kansas Drive Medical Pavilion

  • Rural Health Clinic/Center
  • Paola, KS
National Provider Identifier
1164928347
Registry record updated Sep 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MIAMI COUNTY MEDICAL CENTER INC.
Doing business as
Family Medicine, Kansas Drive Medical Pavilion
Olathe Health Family Medicine-Paola
Practice address
1318 Kansas Dr
Paola, KS 66071-2107
Phone
(913) 445-5678
Fax
(913) 557-5681
NPI assigned
Apr 5, 2018
Last updated
Sep 22, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
MIAMI COUNTY MEDICAL CENTER INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 22, 2026

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

Authorized official

Name
Catherine Wiens
Title
Chief Compliance Officer SWKC
Phone
(913) 445-4459

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1318 Kansas Dr
Paola, KS 66071-2107

Mailing address

2100 Baptiste Dr
Paola, KS 66071-1314
Phone (913) 445-2327

Other names 2

  • Family Medicine, Kansas Drive Medical Pavilion Doing business as
  • Olathe Health Family Medicine-Paola Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180517002206 KS Part A Provider - Rural Health Clinic 2163311457 Practice locations: Paola, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164928347. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
1318 Kansas Dr
Paola, KS 66071-2107
Related CCNs
170049

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

Other NPIs with the same Medicare PAC ID 4

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
17D0448589Family Medicine, Kansas Drive Medical Pavilion1318 Kansas Drive, Paola, KS 66071Certificate of waiverDec 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Miami County Medical CT4 organizations share this tax ID, including this one
Part of
Miami County Medical CT

Other organizations with this tax ID 3

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 30

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

NameRoleSinceShare
Charles Jason Hannagan Individual Corporate OfficerCeo Jul 16, 2019
W-2 Managing EmployeeCeo Jul 16, 2019
Elizabeth Carlton Individual Corporate Director Jan 1, 2023
Sally Maliski Individual Corporate Director Jan 1, 2023
Sherri L Vaughn Individual Corporate Director Jan 1, 2023
Monte Coffman Individual Corporate Director Jan 1, 2023
Debbie Wilkerson Individual Corporate Director Jan 1, 2023
Catherine R Wiens Individual W-2 Managing EmployeeVP/Quality & Chief Compliance Offcr Jan 1, 2014
Talal W Khan Individual Corporate Director Jan 1, 2023
Janell Aust Individual Corporate DirectorBoard Member Jan 1, 2019
Jack a Newman Individual Corporate Director Jan 1, 2023
Elizabeth H King Individual Corporate Director Jan 1, 2023
Gregory Graves Individual Corporate Director Jan 1, 2023
Blake Heid Individual Corporate DirectorBoard Member Jan 1, 2019
Maureen Mahoney Individual Corporate Director Jan 1, 2023
Daniel Peters Individual Corporate Officer Jan 1, 2023
Corporate Director Jan 1, 2023
Douglas a Girod Individual Corporate Director Jan 1, 2023
Robba Moran Individual Corporate Director Jan 1, 2023
Kevin Lockett Individual Corporate Director Jan 1, 2023
David B Dillon Individual Corporate Director Jan 1, 2023
Brenda Dykstra Individual Corporate Director Jan 1, 2023
Douglas Gaston Individual Corporate Director Jan 1, 2023
Robert K Page Individual Corporate Officer Jan 1, 2023
Corporate Director Jan 1, 2023
Akinlolu O Ojo Individual Corporate Director Jan 1, 2023
Romano Delcore Individual Corporate Director Jan 1, 2023
Robert D Simari Individual Corporate Director Jan 1, 2023
Jeffery S. Dossett Individual W-2 Managing EmployeeCoo Jul 16, 2019
Paul Luce Individual W-2 Managing EmployeeVice President/Operations May 27, 2013
University of Kansas Hospital Authority Organization, Kansas City, KS 5% Or Greater Direct Ownership Interest Dec 5, 2023 100%
Jack Beal Individual Corporate Director Jan 1, 2023
Mark Uhlig Individual Corporate Director Jan 1, 2023

Owners & managing parties with NPI records 14

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 14

Facilities with the same owner 25

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 25

Change-of-ownership history 1

DateEventCounterparty
Jun 1, 2018 Change of OwnershipThis provider was the buyer Olathe Health Family Medicine-PaolaCCN 178994, KS, NPI 1952589525

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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": "1522886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790035200000",
    "number": "1164928347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 BAPTISTE DR",
            "city": "PAOLA",
            "state": "KS",
            "postal_code": "660711314",
            "telephone_number": "913-445-2327",
            "fax_number": "913-294-9897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1318 KANSAS DR",
            "city": "PAOLA",
            "state": "KS",
            "postal_code": "660712107",
            "telephone_number": "913-445-5678",
            "fax_number": "913-557-5681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIAMI COUNTY MEDICAL CENTER INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIAMI COUNTY MEDICAL CENTER INC.",
        "enumeration_date": "2018-04-05",
        "last_updated": "2026-09-22",
        "certification_date": "2026-09-22",
        "status": "A",
        "authorized_official_last_name": "WIENS",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER SWKC",
        "authorized_official_telephone_number": "913-445-4459"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine, Kansas Drive Medical Pavilion",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Olathe Health Family Medicine-Paola",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Olathe Health Family Medicine-Paola",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Paola, KS

Sources for this page

Verify at the official NPI Registry.