NPIMap

Organization Active NPI

Mercy Hospital Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Moundridge, KS
National Provider Identifier
1285640912
Registry record updated Feb 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
H059003 Issued in KS
Legal business name
MERCY HOSPITAL INC
Practice address
218 E. Pack Street
Moundridge, KS 67107-0180
Phone
(620) 345-6391
Fax
(620) 345-6344
NPI assigned
Aug 1, 2006
Organization subpart
Yes
Parent organization
MERCY HOSPITAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 23, 2009

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

Authorized official

Name
Mr. Royce Holdeman
Title
Cfo
Phone
(620) 345-6391

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X H059003 KS Primary

Addresses

Primary practice location

218 E. Pack Street
Moundridge, KS 67107-0180

Mailing address

PO Box 180
218 E. Pack Street
Moundridge, KS 67107-0180

Other identifiers 1

IdentifierTypeStateIssuer
000424OtherKSBLUE CROSS BLUE SHIELD SW

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111031000550 KS Part A Provider - Hospital 9436163474 Practice locations: Moundridge, KS

Hospital certification: CCN 17U075

Legal name
MERCY HOSPITAL INC
Doing business as
MERCY HOSPITAL INC
Organization structure
CorporationNon-profit
Incorporated
Feb 9, 1945 in KS
Enrollment address
218 E Pack St
Moundridge, KS 67107-8815
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Part of
Mercy Clinic

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
Donavon Lee Koehn Individual Corporate Director Jan 1, 2020
Vince Koehn Individual Corporate Director Jan 1, 2021
Clifford Koehn Individual Corporate Director Jan 1, 2019
Doyle Wiebe Individual Corporate OfficerSecretary/Treasurer Jan 1, 2020
Corporate DirectorSecretary/Treasurer Jan 1, 2018
Waylan Wiggers Individual Corporate Director Jan 1, 2019
Kendel Koehn Individual Corporate Director May 1, 2020
Aaron J Herbel Individual Corporate OfficerAdministrator and Ceo Apr 4, 2017
W-2 Managing EmployeeAdministrator and Ceo Apr 4, 2017
Lonnie Unruh Individual Corporate Director Jan 1, 2021
Trevor Wiebe Individual W-2 Managing EmployeeOffice Manager Jun 24, 2019
David Becker Individual Corporate Director Jan 1, 2020
Lavern Nikkel Individual Corporate Director Jan 1, 2012
Arlis Ratzlaff Individual Corporate Director Jan 1, 2014
David Litwiller Individual Corporate OfficerAsst. Chairman Jan 1, 2021
Corporate Director Jan 1, 2019
Church of God in Christ Mennonite Organization, Moundridge, KS Non-profit 5% Or Greater Direct Ownership Interest Sep 21, 2011 100%

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Moundridge ManorMoundridge, KS, CCN 175553 Skilled nursing facility Adp of the SNF Oct 1, 2024

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 2

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235347200000",
    "number": "1285640912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 180",
            "address_2": "218 E. PACK STREET",
            "city": "MOUNDRIDGE",
            "state": "KS",
            "postal_code": "671070180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 E. PACK STREET",
            "city": "MOUNDRIDGE",
            "state": "KS",
            "postal_code": "671070180",
            "telephone_number": "620-345-6391",
            "fax_number": "620-345-6344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY HOSPITAL INC",
        "enumeration_date": "2006-08-01",
        "last_updated": "2009-02-23",
        "status": "A",
        "authorized_official_last_name": "HOLDEMAN",
        "authorized_official_first_name": "ROYCE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "620-345-6391",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "KS",
            "license": "H059003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD SW",
            "identifier": "000424",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moundridge, KS

Sources for this page

Verify at the official NPI Registry.