NPIMap

Organization Active NPI

William Newton Memorial Hospital

Doing business as Moline Community Rural Health Clinic

  • Rural Health Clinic/Center
  • Moline, KS
National Provider Identifier
1356360648
Registry record updated Apr 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
173425 Issued in KS
Legal business name
WILLIAM NEWTON MEMORIAL HOSPITAL
Doing business as
Moline Community Rural Health Clinic
Practice address
200 N Plum
Moline, KS 67353
Phone
(620) 647-8109
Fax
(620) 647-3638
NPI assigned
Jul 18, 2006
Last updated
Apr 11, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
WILLIAM NEWTON MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 11, 2023

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

Authorized official

Name
Mr. Joshua Metzinger
Title
Clinic Manager
Phone
(620) 758-2221

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 173425 KS Primary

Addresses

Primary practice location

200 N Plum
Moline, KS 67353

Mailing address

PO Box 155
200 N Plum
Moline, KS 67353-0155
Phone (620) 647-8109

Other identifiers 1

IdentifierTypeStateIssuer
100005090FMedicaidKS

Other names 1

  • Moline Community Rural Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031111000433 KS Part A Provider - Rural Health Clinic 5294648937 Practice locations: Moline, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356360648. Details of each certification follow.

Rural health clinic certification: CCN 173425

Legal name
WILLIAM NEWTON MEMORIAL HOSPITAL
Doing business as
MOLINE COMMUNITY RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 21, 1995
Last certification
Nov 6, 2017
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
200 N Plumb St
PO Box 155
Moline, KS 67353-0155
Related CCNs
171383

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

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
WM Newton Mem Hosp Lab10 organizations share this tax ID, including this one
Part of
WM Newton Mem Hosp Lab

Other organizations with this tax ID 9

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

Locations

200 N Plum St
Moline, KS 67353
Phone (620) 647-8109

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Kara Goff Individual Corporate Officer Jan 1, 2023
Corporate Director Jan 1, 2023
W-2 Managing Employee Jan 1, 2023
Brian James Barta Individual Corporate OfficerChief Financial Officer Aug 1, 2018
Operational/Managerial ControlChief Financial Officer Aug 1, 2018 100%
Joan Cales Individual Corporate OfficerBoard of Trustees Member Aug 1, 2011
Steve McSpadden Individual Corporate OfficerBoard of Trustees Member Sep 1, 2002
William Newton Memorial Hospital Organization, Moline, KS Non-profit Operational/Managerial Control Jul 21, 1995
Other Jul 21, 1995 100%
Diane Lawrence Individual Corporate Officer Jun 1, 2014
Harlene G Hoyt Individual W-2 Managing EmployeeClinic Manager Oct 7, 1996

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Tallgrass RHCSedan, KS, CCN 173423 Rural health clinic Operational/Managerial Control (100%) Jun 5, 1995
Health Professionals of WinfieldWinfield, KS, CCN 178574 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2013
Dexter Community Rural Health ClinicDexter, KS, CCN 173433 Rural health clinic Operational/Managerial Control (100%) Jan 3, 1996
William Newton Hillside Family MedicineWinfield, KS, CCN 178639 Rural health clinic Operational/Managerial Control (100%) Dec 2, 2020

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 7

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": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681171200000",
    "number": "1356360648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 155",
            "address_2": "200 N PLUM",
            "city": "MOLINE",
            "state": "KS",
            "postal_code": "673530155",
            "telephone_number": "620-647-8109",
            "fax_number": "620-647-3638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N PLUM",
            "city": "MOLINE",
            "state": "KS",
            "postal_code": "67353",
            "telephone_number": "620-647-8109",
            "fax_number": "620-647-3638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM NEWTON MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLIAM NEWTON MEMORIAL HOSPITAL",
        "enumeration_date": "2006-07-18",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A",
        "authorized_official_last_name": "METZINGER",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "620-758-2221",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KS",
            "license": "173425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100005090F",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moline Community Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Moline Community Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moline, KS

Sources for this page

Verify at the official NPI Registry.