NPIMap

Hospital District No 1 Marion Co

Organization Active NPI Rural Health Clinic/Center · Marion, KS

NPI 1265617526 · NPPES record last updated Jan 18, 2024

Key facts

NPI
1265617526
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
H057003 (KS)
Legal business name
HOSPITAL DISTRICT NO 1 MARION CO
Practice address
537 S Freeborn St
Marion, KS 66861-1243
Phone
(620) 382-2177
Fax
(620) 382-9104
NPI assigned
Jan 7, 2008
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 4

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

Corporate family (same tax ID) 5

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

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

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D1070391St Luke Medical Clinic
537 South Freeborn, Marion, KS 66861		Provider-performed microscopyJan 25, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in KS

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
Government · Proprietary
Enrollment address
537 S Freeborn St
Marion, KS 66861-1243
Related CCNs
171356

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 Officer
Treasurer		 Jun 24, 2025
Travis L Parmley
Individual 		Corporate Officer
Member		 Jun 24, 2025
Roger Hannaford
Individual 		Corporate Director Jun 27, 2023
Alex Haines
Individual 		W-2 Managing Employee
Ceo		 Aug 30, 2023
Bev Reid
Individual 		W-2 Managing Employee
Cfo		 Sep 30, 2015
Kathy Brenzikofer
Individual 		Corporate Director Oct 30, 2023
Daniel Holub
Individual 		Corporate Director
Secretary		 Jun 23, 2023
Chris Mercer
Individual 		Corporate Director
Vice Chairman		 Jun 22, 2021
Linda K Carlson
Individual 		Corporate Director
Chairman		 Jun 29, 2011

Medicare enrollment records

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

National Provider Directory

Tax ID family
Hospital District No 1 Marion Co (6 organizations share this tax ID)

Specialties & licenses

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

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 identifiers

IdentifierTypeStateIssuer
00225OtherKSBLUE CROSS
17-1356OtherKSMEDICARE
111145OtherKSMEDICARE PROFESSIONAL
20029870CMedicaidKS

Other names

  • St Luke Medical Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 18, 2024.

{
    "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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "00225",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "17-1356",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROFESSIONAL",
            "identifier": "111145",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20029870C",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Luke Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marion, KS

All providers in Marion, KS · Rural Health Clinic/Center in Kansas

Sources for this page

Verify at the official NPI Registry.