NPIMap

Organization Active NPI

Great Plains of Ellinwood Inc.

Doing business as Ellinwood Hospital Clinic

  • Rural Health Clinic/Center
  • Ellinwood, KS
National Provider Identifier
1225040256
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GREAT PLAINS OF ELLINWOOD INC.
Doing business as
Ellinwood Hospital Clinic
Practice address
300 N Park Ave
Ellinwood, KS 67526-1452
Phone
(620) 564-2548
Fax
(620) 564-2491
NPI assigned
Aug 11, 2006
Last updated
Jul 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Authorized official

Name
Mr. Kile Magner
Title
Chief Executive Officer
Phone
(620) 564-2548

Specialties & licenses 1

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

Addresses

Primary practice location

300 N Park Ave
Ellinwood, KS 67526-1452

Mailing address

300 N Park Ave
Ellinwood, KS 67526-1452
Phone (620) 564-2548

Other identifiers 5

IdentifierTypeStateIssuer
110746OtherKSMEDICARE PTAN
1000410070BMedicaidKS
000964OtherKSBCBS 2NDRY FOR RHC
110746OtherKSBLUE CROSS
173402OtherKSMEDICARE PTAN

Other names 1

  • Ellinwood Hospital 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
O20031103000510 KS Part B Supplier - Clinic/Group Practice 5092627539 Receives reassigned benefits from 14 practitioners
Practice locations: Ellinwood, KS
O20100607000885 KS Part A Provider - Rural Health Clinic 5092627539 Practice locations: Ellinwood, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225040256. Details of each certification follow.

Rural health clinic certification: CCN 173402

Legal name
GREAT PLAINS OF ELLINWOOD INC
Doing business as
ELLINWOOD HOSPITAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 5, 1994
Last certification
Dec 21, 2016
Ownership / control type
2B
Most recent change of ownership
Jan 1, 2002 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
300 N Park Ave
Ellinwood, KS 67526-1452
Related CCNs
171301

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).

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
17D0882658Ellinwood Hospital and Clinic300 N Park Ave, Ellinwood, KS 67526Certificate of waiverFeb 14, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Troy L Moore Individual Corporate OfficerCeo Feb 1, 2026 5%
W-2 Managing EmployeeAd; Feb 1, 2026 5%
Operational/Managerial ControlAdministrator Feb 1, 2026 5%
Great Plains Health Alliance Inc Organization, Phillipsburg, KS Operational/Managerial Control May 3, 2010
Rebecca Burns Individual W-2 Managing Employee Jul 1, 2010
Summer Zink Individual Corporate OfficerCfo Jul 1, 2016
Curt Colson Individual Corporate OfficerVP Regional Operations Jan 2, 2015 5%
Operational/Managerial ControlPresident and Ceo Jan 2, 2015 5%

Facilities with the same owner 29

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

View all 29

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1225040256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 N PARK AVE",
            "city": "ELLINWOOD",
            "state": "KS",
            "postal_code": "675261452",
            "telephone_number": "620-564-2548",
            "fax_number": "620-564-2491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N PARK AVE",
            "city": "ELLINWOOD",
            "state": "KS",
            "postal_code": "675261452",
            "telephone_number": "620-564-2548",
            "fax_number": "620-564-2491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT PLAINS OF ELLINWOOD INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A",
        "authorized_official_last_name": "MAGNER",
        "authorized_official_first_name": "KILE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "620-564-2548",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "110746",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000410070B",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS 2NDRY FOR RHC",
            "identifier": "000964",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "110746",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "173402",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellinwood Hospital Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellinwood, KS

Sources for this page

Verify at the official NPI Registry.