NPIMap

Organization Active NPI

Ukhs Great Bend, LLC

  • Rural Health Clinic/Center
  • Great Bend, KS
National Provider Identifier
1245720168
Registry record updated Mar 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
UKHS GREAT BEND, LLC
Practice address
514 Cleveland St
Great Bend, KS 67530-3562
Phone
(620) 792-8833
NPI assigned
May 16, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2020

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

Authorized official

Name
Jesse Mock
Title
Authorized Official
Phone
(620) 791-6272

Specialties & licenses 1

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

Addresses

Primary practice location

514 Cleveland St
Great Bend, KS 67530-3562

Mailing address

514 Cleveland St
Great Bend, KS 67530-3562
Phone (620) 792-8833

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180926003639 KS Part A Provider - Rural Health Clinic 5597016378 Practice locations: Great Bend, KS

Rural health clinic certification: CCN 178557

Legal name
UKHS GREAT BEND LLC
Doing business as
THE UNIVERSITY OF KANSAS HEALTH SYSTEM GREAT BEND CAMPUS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 10, 2010
Last certification
Sep 9, 2010
Ownership / control type
2C
Most recent change of ownership
Aug 1, 2018 (2 total)
Organization structure
LLCProprietary
Enrollment address
514 Cleveland St
Great Bend, KS 67530-3562
Related CCNs
170191

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Ukhs Great Bend LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 31

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

NameRoleSinceShare
Elizabeth Carlton Individual Corporate Director Jan 1, 2024
Christopher B Brown Individual Corporate Director Jan 1, 2025
Timothy a Latimer Individual Corporate Officer Sep 5, 2019
Heath Edward Latham Individual Corporate Director Jan 1, 2024
Jolene Biggs Individual Corporate Director Jan 1, 2024
Ann St. Peter Individual Corporate Director Jan 1, 2024
Mark D Calcara Individual Corporate Director Jan 1, 2024
Monte Coffman Individual Corporate Director Jan 1, 2024
Jean Giddens Individual Corporate Director Jan 1, 2024
Debbie Wilkerson Individual Corporate Director Jan 1, 2024
Steven W Stites Individual Corporate Director Jan 11, 2025
Catherine R Wiens Individual Corporate OfficerChief Compliance Officer SWKC Jul 8, 2025
Jesus Loera Individual Corporate Director Jan 1, 2024
Talal W Khan Individual Corporate Officer Jan 1, 2024
Jack a Newman Individual Corporate Director Jan 1, 2024
Elizabeth H King Individual Corporate Director Jan 1, 2024
Gregory Graves Individual Corporate Director Jan 1, 2024
John Worden Individual Corporate OfficerAdministrator Sep 1, 2023
Maureen Mahoney Individual Corporate Director Jan 1, 2024
Daniel Peters Individual Corporate OfficerSVP General Counsel Sep 1, 2023
Douglas a Girod Individual Corporate Director Jan 1, 2024
Robba Moran Individual Corporate Director Jan 1, 2024
Kevin Lockett Individual Corporate Director Jan 1, 2024
David B Dillon Individual Corporate Director Jan 1, 2024
Donita M. Wolf Individual Corporate Director Jan 1, 2024
Robert K Page Individual Operational/Managerial Control Jan 29, 2020
Akinlolu O Ojo Individual Corporate Director Jan 1, 2024
Romano Delcore Individual Corporate Director Jan 1, 2024
University of Kansas Hospital Authority Organization, Kansas City, KS Non-profit 5% Or Greater Direct Ownership Interest Aug 1, 2018 99%
Matthias a Salathe Individual Corporate Director Jan 1, 2024
Mark Uhlig Individual Corporate Director Jan 1, 2024

Owners & managing parties with NPI records 17

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 17

Facilities with the same owner 25

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

View all 25

Change-of-ownership history 1

DateEventCounterparty
Aug 1, 2018 Change of OwnershipThis provider was the buyer Heartland Regional Health ClinicCCN 178557, KS, NPI 1801022074

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1526428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583884800000",
    "number": "1245720168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 CLEVELAND ST",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675303562",
            "telephone_number": "620-792-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 CLEVELAND ST",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675303562",
            "telephone_number": "620-792-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UKHS GREAT BEND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-16",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A",
        "authorized_official_last_name": "MOCK",
        "authorized_official_first_name": "JESSE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "620-791-6272"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Bend, KS

Sources for this page

Verify at the official NPI Registry.