NPIMap

Organization Active NPI

Fredonia Regional Hospital

  • Critical Access Hospital
  • Fredonia, KS
National Provider Identifier
1285634006
Registry record updated Mar 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
H103001 Issued in KS
Legal business name
FREDONIA REGIONAL HOSPITAL
Practice address
1527 Madison St
Fredonia, KS 66736-1751
Phone
(620) 378-2121
Fax
(620) 378-3169
NPI assigned
Jul 22, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2021

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

Authorized official

Name
Tracy Lynn Row
Title
Business Office Manager
Phone
(620) 378-6204

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Critical Access Hospital 282NC0060X H103001 KS Primary

Addresses

Primary practice location

1527 Madison St
Fredonia, KS 66736-1751

Mailing address

1527 Madison
Fredonia, KS 66736-0579
Phone (620) 378-2121

Other identifiers 7

IdentifierTypeStateIssuer
5698OtherKSBCBS AMBULANCE
305OtherKSBCBS ACUTE IPOP
100102250BMedicaidKS
14075OtherKSBCBS ER PHY
100102550AMedicaidKS
100102550DMedicaidKS
12209OtherKSBCBS CRNA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Fredonia@Fredonia-GPHA.CernerDirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050302000768 KS Part B Supplier - Clinic/Group Practice 5294783270 Receives reassigned benefits from 22 practitioners
3 other NPIs on this enrollment
Practice locations: Fredonia, KS
O20061211000435 KS Part A Provider - Critical Access Hospital 5294783270 Receives reassigned benefits from 9 practitioners
Practice locations: Fredonia, KS

Hospital certification: CCN 171374

Legal name
FREDONIA REGIONAL HOSPITAL
Doing business as
FREDONIA REGIONAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2005
Last certification
Jun 14, 2018
Beds
32 (25 certified)
Ownership / control type
Local
Organization structure
OtherNon-profit
Enrollment address
1527 Madison St
Fredonia, KS 66736-1751
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Fredonia Regional HospitalCCN 171374
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Fredonia Regional EMS5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1527 Madison St
#1
Fredonia, KS 66736

1527 Madison St
Ste 10
Fredonia, KS 66736

1525 Madison St
Fredonia, KS 66736
Phone (620) 378-3341

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/0153994b-73fd-40ca-acc3-d43bb5781a7b/

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Joseph Morris Individual Corporate DirectorBoard Secretary Aug 1, 2019
Susan John Individual Corporate DirectorBoard Member Aug 1, 2023
Charlotte S Svaty Individual Corporate DirectorBoard Member Aug 1, 2021
Jennifer Friend Individual Corporate DirectorBoard Vice-Chair Oct 1, 2017
Gaston Millar Individual Corporate DirectorBoard Member Aug 1, 2020
Jennifer E Jensik Individual Corporate DirectorBoard Member Aug 1, 2020
City of Fredonia Organization, Fredonia, KS Operational/Managerial Control Feb 8, 2007
Johnathan Durrett Individual Corporate Officer Jul 16, 2018
Operational/Managerial ControlCeo Jul 16, 2018
Evan Wayne Dunn Individual Corporate DirectorBoard Member Oct 1, 2017
Jennifer Lawrence Individual W-2 Managing EmployeeHR Director Oct 1, 2017

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
DRS. Morris and Hill Medical ClinicFredonia, KS, CCN 178646 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 4, 2023
Nov 4, 2023

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

Affiliated clinicians 62

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

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615334400000",
    "number": "1285634006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1527 MADISON",
            "city": "FREDONIA",
            "state": "KS",
            "postal_code": "667360579",
            "telephone_number": "620-378-2121",
            "fax_number": "620-378-3169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1527 MADISON ST",
            "city": "FREDONIA",
            "state": "KS",
            "postal_code": "667361751",
            "telephone_number": "620-378-2121",
            "fax_number": "620-378-3169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDONIA REGIONAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-22",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A",
        "authorized_official_last_name": "ROW",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "620-378-6204"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "KS",
            "license": "H103001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS AMBULANCE",
            "identifier": "5698",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ACUTE IPOP",
            "identifier": "305",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100102250B",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ER PHY",
            "identifier": "14075",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100102550A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100102550D",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS CRNA",
            "identifier": "12209",
            "state": "KS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Fredonia@Fredonia-GPHA.CernerDirect.com",
            "affiliation": "N",
            "endpointDescription": "PI_Fredonia, Direct Hospital",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1527 Madison St",
            "city": "Fredonia",
            "state": "KS",
            "country_code": "US",
            "postal_code": "667361751",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fredonia, KS

Sources for this page

Verify at the official NPI Registry.