Cristo Rey Healthcare, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

04-23089 Issued in KS

Legal business name

CRISTO REY HEALTHCARE, LLC

Doing business as

Jesuit Lane Family Practice

Practice address

907A E Jesuit LN
St Marys, KS 66536-9605

Phone

(785) 437-3711

Fax

(785) 437-6711

NPI assigned

Feb 28, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Carl Bruce Carroll, M.D.

Title

Physician

Phone

(785) 437-3711

Specialties & licenses 1

Addresses

Other names 1

• Jesuit Lane Family Practice Doing business as

Locations

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205802279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907A E JESUIT LN",
            "city": "ST MARYS",
            "state": "KS",
            "postal_code": "665369605",
            "telephone_number": "785-437-3711",
            "fax_number": "785-437-6711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907A E JESUIT LN",
            "city": "ST MARYS",
            "state": "KS",
            "postal_code": "665369605",
            "telephone_number": "785-437-3711",
            "fax_number": "785-437-6711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRISTO REY HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "785-437-3711",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-23089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jesuit Lane Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carl Carroll, M.D.
• Verne Claussen, OD
• Community Healthcare System, Inc (St Marys Clinic)
• Community Healthcare System, Inc (St Marys Manor)
• Craig F Schmaltz SP (Kaw Valley Phys Ther & Tng Center)
• Bridget Ann Dinneen, OTR
• Richard Wayne Dinneen, PTA
• DM Sutherland Co LLC (St Marys Pharmacy)
• Dr. Verne E Claussen Jr PA
• James Durbin, DC

• Family Medicine Physician in Saint Marys, KS
• Providers in Saint Marys, KS by specialty
• Family Medicine Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.