NPIMap

Organization Active NPI

West Central Kansas Association, Inc

  • Rural Health Clinic/Center
  • Russell, KS
National Provider Identifier
1215907951
Registry record updated Nov 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
171350A Issued in KS
Legal business name
WEST CENTRAL KANSAS ASSOCIATION, INC
Practice address
222 S Kansas St
Russell, KS 67665-3000
Phone
(785) 483-3131
Fax
(785) 483-4859
NPI assigned
Jan 25, 2006
Organization subpart
Yes
Parent organization
WEST CENTRAL KANSAS ASSOCIATION INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 16, 2022

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

Authorized official

Name
David Caudill
Title
Ceo
Phone
(785) 483-0708

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 171350A KS Primary

Addresses

Primary practice location

222 S Kansas St
Russell, KS 67665-3000

Mailing address

200 S Main St BLDG B
Russell, KS 67665-2920
Phone (785) 483-3131

Other identifiers 2

IdentifierTypeStateIssuer
100306710BMedicaidKS
110498OtherKSBCBS

Other names 1

  • Russell Regional Hospital Physicians Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20021226000022 KS Part A Provider - Rural Health Clinic 4981512001 Practice locations: Russell, KS
O20031218000836 KS Part B Supplier - Clinic/Group Practice 4981512001 Receives reassigned benefits from 15 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Russell, KS

Rural health clinic certification: CCN 178504

Legal name
WEST CENTRAL KANSAS ASSOCIATION INC
Doing business as
RUSSELL REGIONAL HOSPITAL PHYSICIANS CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 3, 2003
Last certification
Mar 14, 2024
Ownership / control type
Non-profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 1998 in KS
Enrollment address
200 S Main St BLDG B
Russell, KS 67665-2920
Related CCNs
171350

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

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
RRH Physicians Clinic

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
David P Caudill Individual W-2 Managing EmployeeCeo Jul 19, 2021
Operational/Managerial ControlCeo Jul 19, 2021
Kenton G Fisher Individual Corporate OfficerCfo Jun 16, 2022
Corporate DirectorCfo Jun 16, 2022
Louis Lix Individual Corporate DirectorIt Meaningful Use Jun 1, 2014
W-2 Managing EmployeeIt Meaningful Use Jun 1, 2014
Kalena N Coleman Individual Corporate DirectorBuiness Office Director Nov 1, 2017
W-2 Managing EmployeeBuiness Office Director Nov 1, 2017

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668556800000",
    "number": "1215907951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S MAIN ST BLDG B",
            "city": "RUSSELL",
            "state": "KS",
            "postal_code": "676652920",
            "telephone_number": "785-483-3131",
            "fax_number": "785-483-4859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S KANSAS ST",
            "city": "RUSSELL",
            "state": "KS",
            "postal_code": "676653000",
            "telephone_number": "785-483-3131",
            "fax_number": "785-483-4859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST CENTRAL KANSAS ASSOCIATION, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WEST CENTRAL KANSAS ASSOCIATION INC",
        "enumeration_date": "2006-01-25",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A",
        "authorized_official_last_name": "CAUDILL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "785-483-0708"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KS",
            "license": "171350A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100306710B",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "110498",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Russell Regional Hospital Physicians Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Russell Regional Hospital Physicians Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Russell, KS

Sources for this page

Verify at the official NPI Registry.