Community Health Center of Southeast Kansas Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS INC

Doing business as

CHC/OK Bartlesville Clinic

Practice address

1223 Swan Dr Ste C
Bartlesville, OK 74006-5037

Phone

(888) 777-9170

NPI assigned

Feb 7, 2023

Last updated

Mar 23, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Daniel Spencer Creitz

Title

Sr VP

Phone

(620) 240-5015

Specialties & licenses 1

Addresses

Other names 1

• CHC/OK Bartlesville Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in OK2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265138580. Details of each certification follow.

• CCN 371009 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 371009

Legal name

COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS INC

Doing business as

CHC/OK BARTLESVILLE CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jun 26, 2023

Last certification

Jun 26, 2023

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Apr 1, 2023 in OK

Enrollment address

1223 Swan Dr
Bartlesville, OK 74006-5037

Other NPIs on the same Medicare enrollment 1

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

• Community Health Center of Southeast Kansas, Inc.

  • Federally Qualified Health Center (FQHC)
  • Miami, OK
  • NPI 1386294213

  O20191202002121

  Same enrollment

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CHCSEK

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.

All facility ownership & control disclosures 19

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

Practitioners 9

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.

• Frances Marie Horn, DO

  • Family Medicine Physician
  • Bartlesville, OK
  • NPI 1154313120
  NPD
• Rhonda Michelle Line, PA-C

  • Physician Assistant
  • Bartlesville, OK
  • NPI 1689666026
  NPD
• Gretchen Elizabeth McGee, MD

  • Family Medicine Physician
  • Bartlesville, OK
  • NPI 1720642432
  NPD
• Aaron Bigando, APRN

  • Family Nurse Practitioner
  • Columbus, KS
  • NPI 1699405845
  NPD
• Ciri Dawn Corbin, APRN

  • Family Nurse Practitioner
  • Columbus, KS
  • NPI 1013268697
  NPD
• Amber D Hunziker, APRN

  • Family Nurse Practitioner
  • Pittsburg, KS
  • NPI 1487021820
  NPD
• Ali Janell Jessee, D.O.

  • Emergency Medicine Physician
  • Benton, KY
  • NPI 1396922118
  NPD
• Courtney Kelso

  • Family Nurse Practitioner
  • Fort Scott, KS
  • NPI 1780268862
  NPD
• Annette Diane Vananne, ARNP, CNM

  • Family Nurse Practitioner
  • Iola, KS
  • NPI 1386846475
  NPD

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

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679529600000",
    "number": "1265138580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1832",
            "city": "PITTSBURG",
            "state": "KS",
            "postal_code": "667621832",
            "telephone_number": "620-231-1960",
            "fax_number": "620-231-2808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1223 SWAN DR STE C",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740065037",
            "telephone_number": "888-777-9170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A",
        "authorized_official_last_name": "CREITZ",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "SPENCER",
        "authorized_official_title_or_position": "SR VP",
        "authorized_official_telephone_number": "620-240-5015"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHC/OK Bartlesville Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ronald Lee Coleman, MD
• Michael Ray Collins, M.D.
• Tahnisha Roja Collins
• Kristin Renee Colliver, CPRSS
• Comforting Hands Hospice LLC.
• Community Health Center of Southeast Kansas, Inc.
• Jennifer L Conant, APRN
• Betty Breanna Conger
• Conhold of Bartlesville, LLC (Adams PARC)
• Shannon Dewayne Conley

• Federally Qualified Health Center (FQHC) in Bartlesville, OK
• Providers in Bartlesville, OK by specialty
• Federally Qualified Health Center (FQHC) in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.