NPIMap

Organization Active NPI

Phillips County Hospital

Doing business as d/b/a Phillips County Medical Clinic

  • Rural Health Clinic/Center
  • Phillipsburg, KS
National Provider Identifier
1366499717
Registry record updated Dec 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PHILLIPS COUNTY HOSPITAL
Doing business as
d/b/a Phillips County Medical Clinic
Practice address
1719 Highway 183
Phillipsburg, KS 67661-2549
Phone
(785) 543-5211
Fax
(785) 543-5274
NPI assigned
May 30, 2006
Last updated
Dec 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2022

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

Authorized official

Name
Tara Overmiller
Title
Coo
Phone
(785) 540-4925

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
General Practice Physician 208D00000X

Addresses

Primary practice location

1719 Highway 183
Phillipsburg, KS 67661-2549

Mailing address

1719 Highway 183
P.O. Box 547
Phillipsburg, KS 67661-2549
Phone (785) 543-5211

Other identifiers 2

IdentifierTypeStateIssuer
100409050BMedicaidKS
100409050DMedicaidKS

Other names 1

  • d/b/a Phillips County Medical 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
O20150304001178 KS Part A Provider - Rural Health Clinic 7012231251 Practice locations: Phillipsburg, KS
O20150706002040 KS Part B Supplier - Clinic/Group Practice 7012231251 Receives reassigned benefits from 39 practitioners
1 other NPI on this enrollment
Practice locations: Phillipsburg, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366499717. Details of each certification follow.

Rural health clinic certification: CCN 178502

Legal name
PHILLIPS COUNTY HOSPITAL
Doing business as
PHILLIPS COUNTY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 1, 2002
Last certification
Nov 14, 2013
Ownership / control type
Non-profit – church related
Most recent change of ownership
Apr 1, 2015 (1 total)
Organization structure
GovernmentNon-profit
Incorporated
in KS
Enrollment address
1719 Hwy 183
Phillipsburg, KS 67661-2549

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

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
17D0670033Phillips County Medical Clinic1719 Hwy 183, Phillipsburg, KS 67661Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/88f6f0ad-680b-460f-ba7c-9dd496dece04/

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
Nancy Johnson Individual W-2 Managing Employee Jun 18, 2021
Jaycie Richardson Individual W-2 Managing Employee Oct 7, 2021
Rex Walk Individual Corporate OfficerCeo Jan 1, 2018
Corporate Director Jan 1, 2018
Other Jan 1, 2018
Brenda Chance Individual W-2 Managing Employee May 19, 2022
Christina Bolin Individual Corporate OfficerCfo May 1, 2021
Corporate DirectorCfo May 1, 2021
W-2 Managing EmployeeCfo May 1, 2021
Phillips County Hospital Organization, Phillipsburg, KS 5% Or Greater Direct Ownership Interest Apr 1, 2015 100%

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Phillips County Health SystemsPhillipsburg, KS, CCN 171353 Hospital Other Apr 1, 2015
Phillips County Health SystemsPhillipsburg, KS, CCN 17Z353 Hospital Other Apr 1, 2015

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 53

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 53

NPI Registry JSON

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671580800000",
    "number": "1366499717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1719 HIGHWAY 183",
            "address_2": "P.O. BOX 547",
            "city": "PHILLIPSBURG",
            "state": "KS",
            "postal_code": "676612549",
            "telephone_number": "785-543-5211",
            "fax_number": "785-543-5274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1719 HIGHWAY 183",
            "city": "PHILLIPSBURG",
            "state": "KS",
            "postal_code": "676612549",
            "telephone_number": "785-543-5211",
            "fax_number": "785-543-5274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILLIPS COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-30",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A",
        "authorized_official_last_name": "OVERMILLER",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "785-540-4925"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100409050B",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100409050D",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "d/b/a Phillips County Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "d/b/a Phillips County Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phillipsburg, KS

Sources for this page

Verify at the official NPI Registry.