NPIMap

Organization Active NPI

Heartland Medical Clinic, Inc

  • Federally Qualified Health Center (FQHC)
  • Lawrence, KS
National Provider Identifier
1356941306
Registry record updated Sep 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEARTLAND MEDICAL CLINIC, INC
Practice address
1803 W 6TH St
Lawrence, KS 66044-1710
Phone
(785) 841-7297
Fax
(785) 856-0375
NPI assigned
Oct 29, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2025

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

Authorized official

Name
Julie Branstrom
Title
Ceo
Phone
(785) 841-7297

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1803 W 6TH St
Lawrence, KS 66044-1710

Mailing address

1312 W 6TH St
Lawrence, KS 66044-2219
Phone (785) 841-7297

Other names 1

  • Heartland @ Panda Pediatrics Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040419001521 KS Part B Supplier - Clinic/Group Practice 2769477645 Receives reassigned benefits from 43 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lawrence, KS
O20201105002143 KS Part A Provider - Federally Qualified Health Center (FQHC) 2769477645 Practice locations: Lawrence, KS

Federally qualified health center certification: CCN 171897

Legal name
HEARTLAND MEDICAL CLINIC INC
Doing business as
HEARTLAND COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 3, 2020
Last certification
Nov 3, 2020
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
1803 W 6TH St
Lawrence, KS 66044-1710

All disclosed owners & managing parties 11

Medicare enrollment files

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

NameRoleSinceShare
Kevyn Gero Individual Corporate Officer Feb 1, 2025
Hatem Chahine Individual Corporate OfficerBoard Member Feb 1, 2025
Doni Mooberry Individual Corporate OfficerTreasurer Apr 1, 2025
Laura M Canelos-Ramon Individual Corporate OfficerBoard Member Jun 1, 2021
Denise Ballard Individual Corporate OfficerBoard Member Feb 1, 2024
Susan Thomas Individual Corporate DirectorBoard Member Jul 1, 2024
William Joseph Anderson Individual Corporate OfficerBoard Member Apr 1, 2025
Leticia Gradington Individual Corporate OfficerBoard Member Jan 1, 2024
Paula Martin Individual Corporate OfficerVice Chair Aug 1, 2022
Julie Branstrom Individual Corporate OfficerCeo Jan 1, 2022
Corporate DirectorCeo Jan 1, 2022
W-2 Managing EmployeeCeo Jan 1, 2022
Anne B Owen Individual Corporate OfficerSecretary Mar 1, 2022

National Provider Directory

National Provider Directory

Owners & managing parties with NPI records 1

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 3

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

Practitioners 37

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

View all 37

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
17D0448208Heartland Community Health Center1803 West 6TH Street, Lawrence, KS 66044Certificate of waiverAug 31, 2026

NPI Registry JSON

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

{
    "created_epoch": "1603929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759190400000",
    "number": "1356941306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1312 W 6TH ST",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660442219",
            "telephone_number": "785-841-7297",
            "fax_number": "785-856-0375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1803 W 6TH ST",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660441710",
            "telephone_number": "785-841-7297",
            "fax_number": "785-856-0375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND MEDICAL CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-29",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A",
        "authorized_official_last_name": "BRANSTROM",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "785-841-7297"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland @ Panda Pediatrics",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Heartland @ Panda Pediatrics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lawrence, KS

Sources for this page

Verify at the official NPI Registry.