NPIMap

Organization Active NPI

Stafford County Hospital

  • Critical Access Hospital
  • Stafford, KS
National Provider Identifier
1295840999
Registry record updated Aug 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
H093002 Issued in KS
Legal business name
STAFFORD COUNTY HOSPITAL
Practice address
502 South Buckeye Street
Stafford, KS 67578-0190
Phone
(620) 234-5221
Fax
(620) 234-5792
NPI assigned
Aug 20, 2006
Last updated
Aug 26, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2014

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

Authorized official

Name
Jo Duvall
Title
Asst. Administrator
Phone
(620) 234-5221

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X H093002 KS Primary

Addresses

Primary practice location

502 South Buckeye Street
Stafford, KS 67578-0190

Mailing address

502 S Buckeye St
Stafford, KS 67578-2035
Phone (620) 234-5221

Other identifiers 3

IdentifierTypeStateIssuer
110930OtherKSBCBS PART B (ER)
100099380AMedicaidKS
000042OtherKSBCBS- HOSPITAL

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061104000699 KS Part A Provider - Critical Access Hospital 3678583382 Receives reassigned benefits from 11 practitioners
Practice locations: Stafford, KS
O20070108000343 KS Part B Supplier - Clinic/Group Practice 3678583382 Receives reassigned benefits from 19 practitioners
Practice locations: Stafford, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295840999. Details of each certification follow.

Hospital certification: CCN 171323

Legal name
STAFFORD COUNTY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Apr 13, 2000
Last certification
Jan 23, 2019
Beds
25
Ownership / control type
Local
Organization structure
GovernmentNon-profit
Enrollment address
502 S Buckeye St
Stafford, KS 67578-2035
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Stafford County HospitalCCN 171323 · All quality measures
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

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Tracy Fanshier Individual Corporate Director Jan 1, 2011
Mary Hildebrand Individual Corporate Director Jan 1, 2009
Boyd Volker Individual Corporate DirectorBoard Member Jan 1, 2011
Ruth Teichman Individual Corporate Director Mar 18, 2013
Todd S Taylor Individual Corporate Officer Dec 1, 2010
W-2 Managing Employee Dec 1, 2010
Jo R Caley Individual Corporate Officer Jan 1, 2011
W-2 Managing Employee Jan 1, 2011

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Stafford County HospitalStafford, KS, CCN 17Z323 Hospital Operational/Managerial Control Dec 1, 2011

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 22

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.

View all 22

Affiliated clinicians 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409011200000",
    "number": "1295840999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 S BUCKEYE ST",
            "city": "STAFFORD",
            "state": "KS",
            "postal_code": "675782035",
            "telephone_number": "620-234-5221",
            "fax_number": "620-234-5792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 SOUTH BUCKEYE STREET",
            "city": "STAFFORD",
            "state": "KS",
            "postal_code": "675780190",
            "telephone_number": "620-234-5221",
            "fax_number": "620-234-5792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAFFORD COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2014-08-26",
        "status": "A",
        "authorized_official_last_name": "DUVALL",
        "authorized_official_first_name": "JO",
        "authorized_official_title_or_position": "ASST. ADMINISTRATOR",
        "authorized_official_telephone_number": "620-234-5221"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "KS",
            "license": "H093002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PART B (ER)",
            "identifier": "110930",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100099380A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS- HOSPITAL",
            "identifier": "000042",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stafford, KS

Sources for this page

Verify at the official NPI Registry.