NPIMap

Organization Active NPI

Coffey County Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Burlington, KS
National Provider Identifier
1255483335
Registry record updated Jan 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
H-016-001 Issued in KS
Legal business name
COFFEY COUNTY HOSPITAL
Practice address
801 N 4TH
Burlington, KS 66839-2602
Phone
(620) 364-2121
Fax
(620) 364-4525
NPI assigned
Jan 17, 2007
Last updated
Jan 15, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2019

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

Authorized official

Name
Merri Michaels
Title
Billing Manager
Phone
(620) 364-2121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X H-016-001 KS Primary

Addresses

Primary practice location

801 N 4TH
Burlington, KS 66839-2602

Mailing address

801 N 4TH
Burlington, KS 66839-2602
Phone (620) 364-2121

Other names 1

  • Coffey County Hospital Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170824000621 KS Part A Provider - Critical Access Hospital 4981598653 Practice locations: Burlington, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255483335. Details of each certification follow.

Hospital certification: CCN 17Z385

Legal name
COFFEY COUNTY HOSPITAL
Organization structure
OtherNon-profit
Incorporated
in KS
Enrollment address
801 N 4TH St
Burlington, KS 66839-2602

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

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory

Member of 1

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

  • County of Coffey

    dba Coffey Co Health Dept

    • State or Local Public Health Clinic/Center
    • Burlington, KS
    • NPI 1285731406

    Member Of

    NPD member

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Peter Allegre Individual Corporate DirectorSecretary Jan 1, 2013
Perry Dale Chapman Individual Corporate DirectorTreasurer Dec 19, 2022
Stacy Nicole Augustyn Individual Corporate OfficerCoo Jul 1, 2022
W-2 Managing EmployeeChief Operating Officer Jul 1, 2022
Jodi Lynn Thomas Individual Corporate DirectorBoard Member Jan 1, 2017
Michael Paul Abendroth Individual Corporate DirectorBoard Member Dec 27, 2023
Coffey County Hospital Organization, Burlington, KS Created for acquisition Other Jan 1, 2017 100%
Stephen Craig Hopkins Individual Corporate Director Jan 1, 2014
Eric Russell Ervin Individual Corporate DirectorBoard Member Jan 2, 2024
Joben Rieth Individual Corporate OfficerCeo Jan 29, 2022 50%
W-2 Managing EmployeeCeo Nov 11, 2021 50%
Jeff Blair Clark Individual Corporate DirectorVice Chair Jan 1, 2016
County of Coffey Organization, Burlington, KS 5% Or Greater Direct Ownership Interest Jul 11, 2017 100%
John R Shell Individual Corporate OfficerChief Medical Officer Aug 1, 1993
W-2 Managing EmployeeCmo Jan 1, 2017 25%
Robert Melvin Fleming Individual Corporate DirectorBoard Member Jan 2, 2024
Arden Wayne Payer Individual Corporate DirectorBoard Member Jan 2, 2024

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Coffey County HospitalBurlington, KS, CCN 171385 Hospital Operational/Managerial Control (100%) Jan 1, 1966
Coffey County Medical Center RHCBurlington, KS, CCN 173982 Rural health clinic 5% Or Greater Direct Ownership Interest (75%) Jan 1, 1966
Waverly Medical ClinicWaverly, KS, CCN 173983 Rural health clinic Operational/Managerial Control (100%) Apr 16, 1991
Yates Center Medical Center Rural Health ClinicYates Center, KS, CCN 178559 Rural health clinic Operational/Managerial Control (100%) Jul 18, 2018

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547510400000",
    "number": "1255483335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 N 4TH",
            "city": "BURLINGTON",
            "state": "KS",
            "postal_code": "668392602",
            "telephone_number": "620-364-2121",
            "fax_number": "620-364-8425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 N 4TH",
            "city": "BURLINGTON",
            "state": "KS",
            "postal_code": "668392602",
            "telephone_number": "620-364-2121",
            "fax_number": "620-364-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COFFEY COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2019-01-15",
        "status": "A",
        "authorized_official_last_name": "MICHAELS",
        "authorized_official_first_name": "MERRI",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "620-364-2121"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "KS",
            "license": "H-016-001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coffey County Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Coffey County Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Burlington, KS

Sources for this page

Verify at the official NPI Registry.