NPIMap

Organization Active NPI

Community Memorial Healthcare, Inc.

Doing business as Community Physicians Clinic

  • Rural Health Clinic/Center
  • Marysville, KS
National Provider Identifier
1295749067
Registry record updated Oct 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COMMUNITY MEMORIAL HEALTHCARE, INC.
Doing business as
Community Physicians Clinic
Practice address
1902 May St
Marysville, KS 66508-1200
Phone
(785) 562-3942
Fax
(785) 562-5149
NPI assigned
Jul 28, 2006
Last updated
Oct 14, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY MEMORIAL HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 14, 2026

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

Authorized official

Name
Tom Hood
Title
Interim Ceo
Phone
(785) 562-2348

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1902 May St
Marysville, KS 66508-1200

Mailing address

1902 May St
Marysville, KS 66508-1200
Phone (785) 562-3942

Other names 1

  • Community Physicians 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
O20040304000181 KS Part B Supplier - Clinic/Group Practice 6608763503 Receives reassigned benefits from 14 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marysville, KS; Axtell, KS; Blue Rapids, KS
O20050207000014 KS Part A Provider - Rural Health Clinic 6608763503 Practice locations: Marysville, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295749067. Details of each certification follow.

Rural health clinic certification: CCN 173404

Legal name
COMMUNITY MEMORIAL HEALTHCARE INC
Doing business as
COMMUNITY PHYSICIANS CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 1994
Last certification
Jan 3, 2019
Ownership / control type
1B
Organization structure
CorporationNon-profit
Enrollment address
1902 May St
Marysville, KS 66508-1200
Related CCNs
171363

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 5

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
17D0449950Community Physicians Clinic1902 May, Marysville, KS 66508Certificate of waiverJun 21, 2028

National Provider Directory

National Provider Directory
Tax ID family
Community Memorial HLTH Inc11 organizations share this tax ID, including this one
Part of
Community Memorial HLTH Inc

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Jeff Crist Individual Corporate OfficerVice Chair of Board May 1, 2023
West Town Bank and Trust Organization, North Riverside, IL Financial institution 5% Or Greater Mortgage Interest Dec 19, 2018 22%
Sandra Keller Individual Corporate DirectorDirector Jul 1, 2023
Kevin O'Neil Individual Corporate DirectorDirector Jul 1, 2023
Thomas R Hood Individual Corporate OfficerInterim Ceo Jan 22, 2026
W-2 Managing EmployeeInterim Ceo Jan 22, 2026
Melisa Treff Individual Corporate Director Jan 15, 2025
Usda Department of Agriculture Rural Development Organization, Topeka, KS 5% Or Greater Mortgage Interest Dec 19, 2018 32%
Gary Holle Individual Corporate DirectorDirector Jul 1, 2023
Jacob M Nagely Individual W-2 Managing EmployeeChief of Medical Staff Jan 15, 2025
Randall J Brown Individual Corporate Director Jan 15, 2025
Lora Beikmann Individual Corporate DirectorDirector Jul 1, 2023
Edward Popejoy Individual Corporate OfficerChairman of the Board May 1, 2023
Barbara Kickhaefer Individual Corporate Director Jan 15, 2025
Erin Wright Individual Corporate DirectorDirector May 16, 2018
Daniel Fehr Individual Corporate OfficerCfo Jul 1, 2023
W-2 Managing EmployeeCfo Jul 1, 2023
Kurt Robert Olson Individual Corporate Director Jan 15, 2025
Austin Schotte Individual Corporate Director Jan 15, 2025

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791936000000",
    "number": "1295749067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1902 MAY ST",
            "city": "MARYSVILLE",
            "state": "KS",
            "postal_code": "665081200",
            "telephone_number": "785-562-3942",
            "fax_number": "785-562-5149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1902 MAY ST",
            "city": "MARYSVILLE",
            "state": "KS",
            "postal_code": "665081200",
            "telephone_number": "785-562-3942",
            "fax_number": "785-562-5149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEMORIAL HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY MEMORIAL HEALTHCARE, INC.",
        "enumeration_date": "2006-07-28",
        "last_updated": "2026-10-14",
        "certification_date": "2026-10-14",
        "status": "A",
        "authorized_official_last_name": "HOOD",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "INTERIM CEO",
        "authorized_official_telephone_number": "785-562-2348"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Physicians Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marysville, KS

Sources for this page

Verify at the official NPI Registry.