NPIMap

Organization Active NPI

Heart of Kansas Family Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Great Bend, KS
National Provider Identifier
1184739443
Registry record updated May 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEART OF KANSAS FAMILY HEALTH CARE, INC.
Practice address
1905 19TH St
Great Bend, KS 67530-2502
Phone
(620) 792-5700
Fax
(855) 463-0851
NPI assigned
Aug 20, 2006
Last updated
May 8, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2026

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

Authorized official

Name
Mr. Freddy Gunn
Title
Cfo
Phone
(620) 792-5700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

1905 19TH St
Great Bend, KS 67530-2502

Mailing address

1905 19TH St
Great Bend, KS 67530-2502
Phone (620) 792-5700

Other practice location 1

1821 Kansas Ave
Great Bend, KS 67530-2501
Phone (620) 603-6838

Other practice location 2

609 E 1st Ave
St John, KS 67576-2223
Phone (620) 377-5031

Other practice location 3

412 Grand Ave
Stafford, KS 67578-2010
Phone (620) 234-2700

Other practice location 4

522 Broadway St
Larned, KS 67550-3042
Phone (620) 804-6100

Other identifiers 4

IdentifierTypeStateIssuer
30003932810007MedicaidKS
461035OtherKSCHILDRENS MERCY
160510OtherKSBLUE SHIELD
DC6555OtherKSRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030911000025 KS Part A Provider - Federally Qualified Health Center (FQHC) 4486565181 Practice locations: Great Bend, KS
O20040228000455 KS Part B Supplier - Clinic/Group Practice 4486565181 Receives reassigned benefits from 21 practitioners
Practice locations: Stafford, KS; St John, KS; Larned, KS; Great Bend, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184739443. Details of each certification follow.

Federally qualified health center certification: CCN 171817

Legal name
HEART OF KANSAS FAMILY HEALTH CARE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 1, 2002
Last certification
Mar 1, 2002
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 5, 2008 in KS
Enrollment address
1905 19TH St
Great Bend, KS 67530-2502

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
17D0971317Heart of Kansas Family Health Care, Inc1905 19TH Street, Great Bend, KS 67530Provider-performed microscopyMar 9, 2028

National Provider Directory

National Provider Directory

Locations

1821 Kansas Ave
Great Bend, KS 67530
Phone (620) 603-6838

1905 19th St
Great Bend, KS 67530
Phone (620) 792-5700

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Guadalupe Allende Individual Corporate DirectorBoard Member Feb 1, 2012
William B Middleton Individual Corporate DirectorCeo Sep 23, 2013
Operational/Managerial ControlCeo Sep 23, 2013
Jyl Nokes Individual Corporate DirectorCoo Aug 4, 2003
Martha Rivas Individual Corporate DirectorBoard Member Sep 1, 2008
Mildred Hill Individual Corporate DirectorBoard Member Sep 1, 1997
Sara Love Individual Corporate DirectorBoard Member Oct 1, 2015
Joleen Tustin Individual Corporate DirectorBoard Member Jul 1, 2006

Practitioners & affiliated clinicians

Practitioners 28

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.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778198400000",
    "number": "1184739443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 19TH ST",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675302502",
            "telephone_number": "620-792-5700",
            "fax_number": "855-463-0851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 19TH ST",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675302502",
            "telephone_number": "620-792-5700",
            "fax_number": "855-463-0851"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1821 Kansas Ave",
            "address_purpose": "LOCATION",
            "city": "Great Bend",
            "state": "KS",
            "postal_code": "675302501",
            "country_code": "US",
            "telephone_number": "620-603-6838",
            "fax_number": "855-463-0851",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "609 E 1st Ave",
            "address_purpose": "LOCATION",
            "city": "St John",
            "state": "KS",
            "postal_code": "675762223",
            "country_code": "US",
            "telephone_number": "620-377-5031",
            "fax_number": "833-973-4734",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "412 Grand Ave",
            "address_purpose": "LOCATION",
            "city": "Stafford",
            "state": "KS",
            "postal_code": "675782010",
            "country_code": "US",
            "telephone_number": "620-234-2700",
            "fax_number": "855-463-0855",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "522 Broadway St",
            "address_purpose": "LOCATION",
            "city": "Larned",
            "state": "KS",
            "postal_code": "675503042",
            "country_code": "US",
            "telephone_number": "620-804-6100",
            "fax_number": "855-463-0853",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HEART OF KANSAS FAMILY HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2026-05-08",
        "certification_date": "2026-05-08",
        "status": "A",
        "authorized_official_last_name": "GUNN",
        "authorized_official_first_name": "FREDDY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "620-792-5700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30003932810007",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHILDRENS MERCY",
            "identifier": "461035",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "160510",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC6555",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Bend, KS

Sources for this page

Verify at the official NPI Registry.