Community Memorial Healthcare, Inc.
Organization Active NPI Rural Health Clinic/Center · Marysville, KS
NPI 1295749067 · NPPES record last updated Aug 26, 2026
Key facts
- NPI
- 1295749067
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- COMMUNITY MEMORIAL HEALTHCARE, INC.
- Practice address
- 1902 May St
Marysville, KS 66508-1200 - Phone
- (785) 562-3942
- Fax
- (785) 562-5149
- NPI assigned
- Jul 28, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- COMMUNITY MEMORIAL HEALTHCARE, INC.
Authorized official
- Name
- Vicki M Volle
- Title
- Controller
- Phone
- (785) 562-4384
Owners & managing parties with NPI records 2
-
Jacob M Nagely, M.D.
-
Kurt Robert Olson, O.D.
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 10
Related certifications (CCN) 1
Practitioners 20
-
Andrea Blumer, APRN
-
Ben M Bruna, M.D.
-
John A Haefele, M.D.
-
Rebecca Ann Heuer, A.P.R.N.
-
Jacob M Nagely, M.D.
-
Cheryl A Rice, M.D.
-
Dayna K Scheele, ARNP
-
Shane E. Thoreson, M.D.
-
Linda Marie Bott, ARNP
-
Anne C Bruna, ARNP
-
Levi Lear, PA-C
-
Thuy Nguyen, APRN
-
Cheryl E Shanks, ARNP
-
Michael J Stech, CRNA
-
Michele K Voelker, ARNP
-
Chance Williams, M.D.
-
David L Samani, M.D.
-
Theodore L Kitowski, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D0449950 | Community Physicians Clinic | Certificate of waiver | Jun 21, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KS
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
- Corporation · Non-profit
- Enrollment address
- 1902 May St
Marysville, KS 66508-1200 - Related CCNs
- 171363
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Jeff Crist |
Corporate Officer |
May 1, 2023 | |
| West Town Bank and Trust |
5% Or Greater Mortgage Interest | Dec 19, 2018 | 22% |
| Sandra Keller |
Corporate Director |
Jul 1, 2023 | |
| Kevin O'Neil |
Corporate Director |
Jul 1, 2023 | |
| Thomas R Hood |
Corporate Officer |
Jan 22, 2026 | |
| W-2 Managing Employee |
Jan 22, 2026 | ||
| Melisa Treff |
Corporate Director | Jan 15, 2025 | |
| Usda Department of Agriculture Rural Development |
5% Or Greater Mortgage Interest | Dec 19, 2018 | 32% |
| Gary Holle |
Corporate Director |
Jul 1, 2023 | |
| Jacob M Nagely |
W-2 Managing Employee |
Jan 15, 2025 | |
| Randall J Brown |
Corporate Director | Jan 15, 2025 | |
| Lora Beikmann |
Corporate Director |
Jul 1, 2023 | |
| Edward Popejoy |
Corporate Officer |
May 1, 2023 | |
| Barbara Kickhaefer |
Corporate Director | Jan 15, 2025 | |
| Erin Wright |
Corporate Director |
May 16, 2018 | |
| Daniel Fehr |
Corporate Officer |
Jul 1, 2023 | |
| W-2 Managing Employee |
Jul 1, 2023 | ||
| Kurt Robert Olson |
Corporate Director | Jan 15, 2025 | |
| Austin Schotte |
Corporate Director | Jan 15, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Community Physicians CL
- Part of
- Community Physicians CL
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CE9160 | Other | KS | RAILROAD MEDICARE |
| 10005390G | Medicaid | KS | |
| 016863 | Other | KS | BLUE CROSS/BLUE SHIELD KS |
Other names
- Community Physicians Clinic
Other providers in Marysville, KS
- Mercy Chepleting
- Community Healthcare System, Inc
- Community Memorial Healthcare, Inc
- Community Memorial Healthcare, Inc.
- Community Memorial Healthcare, Inc.
- Community Memorial Healthcare, Inc.
- Community Memorial Healthcare, Inc.
- Community Memorial Healthcare, Inc.
- Community Memorial Healthcare, Inc.
- Community Memorial Healthcare, Inc.
All providers in Marysville, KS · Rural Health Clinic/Center in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.