Shawnee Mission Medical Center Inc
Organization Active NPI Clinical Medical Laboratory · Merriam, KS
NPI 1235792003 · NPPES record last updated Jan 25, 2024
Key facts
- NPI
- 1235792003
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- Legal business name
- SHAWNEE MISSION MEDICAL CENTER INC
- Practice address
- 9100 W 74TH St
Merriam, KS 66204-4004 - Phone
- (913) 676-2000
- NPI assigned
- Apr 17, 2019
- Organization subpart
- No
Authorized official
- Name
- Mairilise Pothin Owen
- Title
- Cfo
- Phone
- (913) 676-2153
Owners & managing parties with NPI records 3
-
Abigail Rose Proffer, M.D.
-
Reagan M Wittek, M.D.
Other NPIs on the same Medicare enrollment 1
Related certifications (CCN) 1
Affiliated clinicians 927
-
Amel Tareq Abbas, PA
-
Lindsey Bagby Abraham, CRNA
-
Shelly L Acord, CRNA
-
Kristin M Adams, MD
-
Robb A. Aerni, CRNA
-
Anthony A Albracht, M.D.
-
Masarah Alfraih, CRNA
-
James Eric Allen, M.D.
-
Martha Ann Allen, M.D.
-
Jonathan Vernon Amos, M.D.
-
Man M Anand, MD
-
Andy Lee Anderson, M.D.
-
David Warner Anderson, M.D.
-
Mackenzie Anderson, APRN-NP
-
Rebecca A Anderson, P.A.
-
Rebecca Andrews, APRN FNP-C
-
Emily Marie Anton, M.D.
Medicare Care Compare: Hospital
- Listed as
- Adventhealth Shawnee Mission
- Overall star rating
- ★★★☆☆ 3 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D0648205 | Advent Health - Shawnee Mission | Accreditation | Feb 8, 2027 |
| 17D2014505 | Advent Health-Shawnee Mission | Certificate of waiver | Oct 11, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Hospital certification: CCN 170104
- Legal name
- SHAWNEE MISSION MEDICAL CENTER INC
- Doing business as
- ADVENTHEALTH SHAWNEE MISSION
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jun 6, 1988
- Last certification
- Mar 5, 2024
- Beds
- 504
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 9100 W 74TH St
Shawnee Mission, KS 66204-4004 - Hospital subgroups
- General, Psychiatric unit
All disclosed owners & managing parties 29
| Name | Role | Since | Share |
|---|---|---|---|
| Gary Thurber |
Corporate Director |
Sep 17, 2015 | |
| David Vandevere |
Corporate Director |
Dec 12, 2023 | |
| Gregory Maddux |
Corporate Director |
Jan 1, 2006 | |
| Samuel Caughron |
Corporate Director |
Dec 12, 2023 | |
| Timothy R. Rodgers |
Corporate Officer |
May 25, 2021 | |
| Corporate Director |
Jan 1, 2000 | ||
| Reagan M Wittek |
Corporate Director |
Dec 12, 2019 | |
| Rodney Allen |
Contracted Managing Employee |
Jul 15, 2025 | |
| Corporate Officer |
Jul 15, 2025 | ||
| Operational/Managerial Control |
Jul 15, 2025 | ||
| Karsten Randolph |
Corporate Officer |
Apr 1, 2014 | |
| Corporate Director |
Apr 1, 2014 | ||
| Barbara Cusick |
Corporate Director |
Feb 24, 2011 | |
| Adventisit Health Mid-America Inc |
5% Or Greater Direct Ownership Interest | Nov 1, 2011 | 100% |
| Andrew D Jahn |
Corporate Director |
Apr 1, 2024 | |
| Abigail R Proffer |
Corporate Director |
Dec 12, 2023 | |
| Twyla Rist |
Corporate Director |
Dec 12, 2023 | |
| Sam Huenergardt |
Corporate Officer |
Apr 1, 2024 | |
| Corporate Director |
Jun 7, 2018 | ||
| Michael Saunders |
Corporate Officer |
Feb 22, 2007 | |
| Sissel Jacob |
Contracted Managing Employee |
Jul 15, 2025 | |
| Corporate Officer |
Jul 15, 2025 | ||
| Operational/Managerial Control |
Jul 15, 2025 | ||
| Paul C Rathbun |
Corporate Officer |
Sep 11, 2014 | |
| Stephen Williams |
Corporate Director |
Dec 12, 2023 | |
| Adventist Health System Sunbelt Healthcare Corporation |
5% Or Greater Indirect Ownership Interest | Nov 1, 2002 | 100% |
| Lyle Pishny |
Corporate Director |
Jan 29, 2008 | |
| Ronald Carlson |
Corporate Director |
Jan 1, 2006 | |
| Alan David Verrill |
Contracted Managing Employee |
Feb 25, 2024 | |
| Corporate Officer |
Dec 12, 2023 | ||
| Corporate Director |
Feb 25, 2024 | ||
| Operational/Managerial Control |
Feb 25, 2024 | ||
| Toni Berrios |
Corporate Officer |
Jun 1, 2024 | |
| Stephanie Rosentreter |
Contracted Managing Employee | Oct 5, 2025 | |
| Corporate Officer |
Oct 5, 2025 | ||
| Operational/Managerial Control |
Oct 5, 2025 | ||
| David L Huffman |
Corporate Officer |
Dec 12, 2019 | |
| Roger Bernard |
Corporate Director |
Jun 9, 2016 | |
| Lynn Addiscott |
Corporate Officer |
Jan 26, 2004 | |
| Lee Rochholz |
Corporate Director |
Jul 1, 2024 | |
| Adventist Health System Sunbelt Inc |
5% Or Greater Indirect Ownership Interest | Nov 1, 2002 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030923000057 | KS | Part a Provider - Hospital | 1153239298 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Yes |
Addresses
Primary practice location
9100 W 74TH St
Merriam, KS 66204-4004
Mailing address
7315 E Frontage Rd Ste 202
Merriam, KS 66204-1658
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler | Other | SHAWNEE MISSION MEDICAL CENTER INC |
Other providers in Merriam, KS
- Umang Harshadkumar Shah
- Kimberly Kay Shara
- Michael J Shara
- Shawnee Mission Health Care, Inc
- Shawnee Mission Medical Center Inc
- Shawnee Mission Medical Center Inc
- Shawnee Mission Medical Center Inc
- Shawnee Mission Surgery Center LLC
- Kara Shelman
- Randy M Sheridan
All providers in Merriam, KS · Clinical Medical Laboratory in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 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.