NPIMap

Organization Active NPI

Hospital District No 1 Marion Co

Doing business as St Luke Medical Clinic

  • Rural Health Clinic/Center
  • Marion, KS
National Provider Identifier
1265617526
Registry record updated Jan 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H057003 Issued in KS
Legal business name
HOSPITAL DISTRICT NO 1 MARION CO
Doing business as
St Luke Medical Clinic
Practice address
537 S Freeborn St
Marion, KS 66861-1243
Phone
(620) 382-2177
Fax
(620) 382-9104
NPI assigned
Jan 7, 2008
Last updated
Jan 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2024

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

Authorized official

Name
Alex Haines
Title
Ceo
Phone
(620) 382-2177

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X H057003 KS Primary

Addresses

Primary practice location

537 S Freeborn St
Marion, KS 66861-1243

Mailing address

535 S Freeborn St
Marion, KS 66861-1256
Phone (620) 382-2177

Other names 1

  • St Luke Medical 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
O20050428000824 KS Part B Supplier - Clinic/Group Practice 7517923196 Receives reassigned benefits from 44 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marion, KS
O20080502000438 KS Part A Provider - Rural Health Clinic 7517923196 Practice locations: Marion, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265617526. Details of each certification follow.

Rural health clinic certification: CCN 178551

Legal name
HOSPITAL DISTRICT NO 1 MARION CO
Doing business as
ST LUKE MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 20, 2009
Last certification
Mar 18, 2025
Ownership / control type
For profit – corporation
Organization structure
GovernmentProprietary
Enrollment address
537 S Freeborn St
Marion, KS 66861-1243
Related CCNs
171356

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 1

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

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
17D1070391St Luke Medical Clinic537 South Freeborn, Marion, KS 66861Provider-performed microscopyJan 25, 2028

National Provider Directory

National Provider Directory
Tax ID family
Hospital District No 1 Marion Co6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Ryan Edmundson Individual Corporate OfficerTreasurer Jun 24, 2025
Travis L Parmley Individual Corporate OfficerMember Jun 24, 2025
Roger Hannaford Individual Corporate Director Jun 27, 2023
Alex Haines Individual W-2 Managing EmployeeCeo Aug 30, 2023
Bev Reid Individual W-2 Managing EmployeeCfo Sep 30, 2015
Kathy Brenzikofer Individual Corporate Director Oct 30, 2023
Daniel Holub Individual Corporate DirectorSecretary Jun 23, 2023
Chris Mercer Individual Corporate DirectorVice Chairman Jun 22, 2021
Linda K Carlson Individual Corporate DirectorChairman Jun 29, 2011

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1199664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705536000000",
    "number": "1265617526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 S FREEBORN ST",
            "city": "MARION",
            "state": "KS",
            "postal_code": "668611256",
            "telephone_number": "620-382-2177",
            "fax_number": "620-382-9104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "537 S FREEBORN ST",
            "city": "MARION",
            "state": "KS",
            "postal_code": "668611243",
            "telephone_number": "620-382-2177",
            "fax_number": "620-382-9104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL DISTRICT NO 1 MARION CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-07",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A",
        "authorized_official_last_name": "HAINES",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "620-382-2177"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KS",
            "license": "H057003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Luke Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marion, KS

Sources for this page

Verify at the official NPI Registry.