Community Health Center of Southeast Kansas, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Pittsburg, KS
NPI 1174525943 · NPPES record last updated Jul 22, 2024
Key facts
- NPI
- 1174525943
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC
- Practice address
- 924 N Broadway St
Pittsburg, KS 66762-3910 - Phone
- (620) 670-8070
- NPI assigned
- Aug 11, 2005
- Organization subpart
- No
Authorized official
- Name
- Daniel Spencer Creitz
- Title
- Senior Vice President
- Phone
- (620) 240-5015
Other NPIs on the same Medicare enrollment 23
Corporate family (same tax ID) 42
Practitioners 96
-
Miranda Dawn Plumlee, APRN
-
Kayla Tinsley, APRN
-
Jay Allen, M.D.
-
Kristen Marie Anderson, DNP, APRN, FNP-C
-
Lisa Ayala, MD
-
Emily Kate Baker, DO
-
Tamara Erin Battagler, APRN
-
Linda K Bean, D.O.
-
Aaron Bigando, APRN
-
Brenda S Brennan, APRN
-
Kelsey Bruns, MSN, FNP-C
-
William T Carl, APRN
-
Stormy D Carter, NP
-
Sara M Clift, PA
-
Natalie Jean Cooper, APRN
-
Ciri Dawn Corbin, APRN
-
Jessica Cornett, FNP-C
-
Tarah Cuppett, APRN
-
Joanna L Curl, PA-C
-
Samantha Curran, PT, DPT
-
Whitney Anne Dickerson, APRN-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D2307732 | Community Health Center of Southeast Kansas | Certificate of waiver | Jul 14, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KS
Federally qualified health center certification: CCN 171851
- Legal name
- COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 24, 2014
- Last certification
- Mar 24, 2014
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 20, 2001 in KS
- Enrollment address
- 924 N Broadway St
Pittsburg, KS 66762-3910
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Rachel Ruiz |
Corporate Officer | Jan 1, 2023 | |
| Krista Kay Postai |
Corporate Director | Nov 2, 2004 | |
| W-2 Managing Employee |
Nov 2, 2004 | ||
| David Shepherd |
Corporate Officer | Apr 18, 2019 | |
| Nancy Haire |
Corporate Officer |
Nov 1, 2021 | |
| Judy a. Westhoff |
Corporate Officer |
Nov 1, 2002 | |
| Brian Jones |
Corporate Officer |
Nov 1, 2007 | |
| Sandra Cobos Cenobio |
Corporate Director |
Apr 20, 2023 | |
| Shawn Naccarato |
Corporate Officer |
Aug 20, 2020 | |
| Jason M Wesco |
Corporate Officer | Jan 1, 2001 | |
| Dawn Flores |
Corporate Officer | Nov 1, 2005 | |
| Daniel Creitz |
Corporate Director |
Jan 1, 2022 | |
| W-2 Managing Employee | Jan 1, 2022 | ||
| Karen Waddell |
Corporate Officer |
Aug 15, 2024 | |
| Jake Letner |
Corporate Officer |
Jun 1, 2021 | |
| Alysia Johnston |
Corporate Officer |
Nov 1, 2023 | |
| Patrick O'Bryan |
Corporate Officer |
Nov 1, 2017 |
All facility ownership & control disclosures 19
| Facility | Type | Role | Since |
|---|---|---|---|
| Community Health Center of Southeast Kansas Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Nov 15, 2011 |
| Community Health Center of Southeast Kansas/Coffeyville |
Federally qualified health center | Operational/Managerial Control (100%) | Jan 2, 2012 |
| Community Health Center of Southeast Kansas/Iola |
Federally qualified health center | Operational/Managerial Control (100%) | Dec 1, 2008 |
| CHC/Sek'S Field Kindley Student Health Center |
Federally qualified health center | Operational/Managerial Control | Oct 15, 2013 |
| Community Health Center of Southeast Kansas Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Jun 2, 2014 |
| Community Health Center of Southeast Kansas/Parsons |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 31, 2015 |
| Community Health Center of Southeast Kansas/Pleasanton |
Federally qualified health center | Operational/Managerial Control (100%) | Dec 31, 2018 |
| CHC/Sek Arma Clinic |
Federally qualified health center | Operational/Managerial Control (100%) | Dec 31, 2018 |
| Community Health Center of Southeast Kansas Inc/Fort Scott Main Clinic |
Federally qualified health center | Operational/Managerial Control (100%) | Dec 31, 2018 |
| Community Health Center of Southeast Kansas/Mound City |
Federally qualified health center | Operational/Managerial Control (100%) | Dec 31, 2018 |
| CHC/Ok Miami Clinic |
Federally qualified health center | Operational/Managerial Control | Nov 20, 2019 |
| Community Health Center of Southeast Kansas Inc |
Federally qualified health center | Operational/Managerial Control | Oct 17, 2018 |
| CHC/Sek South Pittsburg |
Federally qualified health center | Operational/Managerial Control | Apr 17, 2020 |
| Community Health Center of Southeast Kansas Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Sep 24, 2021 |
| Community Health Center of Southeast Kansas Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Nov 7, 2022 |
| Community Health Center of Southeast Kansas Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Feb 1, 2023 |
| Community Health Center of Southeast Kansas Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Jan 1, 2023 |
| Community Health Center of Southeast Kansas Inc |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2023 |
| Community Health Center of Southeast Kansas Inc |
Federally qualified health center | Operational/Managerial Control | Apr 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040209000163 | KS | Part B Supplier - Clinic/Group Practice | 7911816392 |
Receives reassigned benefits from 184 practitioners 23 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Parsons, KS; Pleasanton, KS; Pittsburg, KS; Mound City, KS; La Cygne, KS; Iola, KS; Independence, KS; Garnett, KS… |
| O20140314000180 | KS | Part a Provider - Federally Qualified Health Center (FQHC) | 7911816392 | Practice locations: Pittsburg, KS |
National Provider Directory
- Tax ID family
- Community Health Center of Southeast Kanas Inc
Locations
1216 Hawaii Rd
Humboldt, KS 66748
Phone (620) 473-1002
106 NW Veterans Blvd
Miami, OK 74354
Phone (918) 238-2410
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
924 N Broadway St
Pittsburg, KS 66762-3910
Mailing address
PO Box 1832
Pittsburg, KS 66762-1832
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30003958250013 | Medicaid | KS | |
| 171851 | Other | KS | MEDICARE |
| 200099190A | Medicaid | OK |
Other providers in Pittsburg, KS
- Comfortcare Homes of Pittsburg LLC
- Community Health Center of Southeast Kanas, Inc.
- Community Health Center of Southeast Kanas, Inc.
- Community Health Center of Southeast Kanas, Inc.
- Community Health Center of Southeast Kansas Inc
- Community Health Center of Southeast Kansas, Inc
- Community Health Center of Southeast Kansas, Inc.
- Community Health Center of Southeast Kansas, Inc.
- Community Health Center of Southeast Kansas, Inc.
- Community Health Center of Southeast Kansas, Inc.
All providers in Pittsburg, KS · Federally Qualified Health Center (FQHC) in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2024. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.