Phillips County Hospital
Organization Active NPI Rural Health Clinic/Center · Phillipsburg, KS
NPI 1366499717 · NPPES record last updated Dec 21, 2022
Key facts
- NPI
- 1366499717
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- PHILLIPS COUNTY HOSPITAL
- Practice address
- 1719 Highway 183
Phillipsburg, KS 67661-2549 - Phone
- (785) 543-5211
- Fax
- (785) 543-5274
- NPI assigned
- May 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Tara Overmiller
- Title
- Coo
- Phone
- (785) 540-4925
Owners & managing parties with NPI records 3
Owned or controlled facilities with NPI records 3
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 3
Practitioners 54
-
Shelly Cote, APRN
-
Edward Theodore Duensing, NP-C
-
Kai Thomas Englert, P.A.
-
Jennifer L Hamons, P.A.
-
Theresia A Neill, M.D.
-
Jose Luis Renteria, ACNP
-
Emily Christine Whitney, APRN
-
Tyson Brant Wisinger, M.D.
-
Robyn R. Burwell, A.R.N.P., PMHNP-BC
-
Sarah Rose Castle, APRN
-
Alex Nicole Cotten, APRN
-
Paul J Jaster, MD
-
Sheri Jonsson, MS, RD, LD
-
Cooper L Nickel, M.D.
-
Julie Lynn Siefers, PA-C
-
Robert Sourk, MD
-
Kendell Dwayne Varner, PHYSICIAN ASSISTANT
-
Tracy Michelle Ander, D.O.
-
Melissa Renee Berg, FNP
-
Pavankumar Bommasamudram, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D0670033 | Phillips County Medical Clinic | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KS
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
- Government · Non-profit
- Incorporated
- in KS
- Enrollment address
- 1719 Hwy 183
Phillipsburg, KS 67661-2549
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Nancy Johnson |
W-2 Managing Employee | Jun 18, 2021 | |
| Jaycie Richardson |
W-2 Managing Employee | Oct 7, 2021 | |
| Rex Walk |
Corporate Officer |
Jan 1, 2018 | |
| Corporate Director | Jan 1, 2018 | ||
| Other | Jan 1, 2018 | ||
| Brenda Chance |
W-2 Managing Employee | May 19, 2022 | |
| Christina Bolin |
Corporate Officer |
May 1, 2021 | |
| Corporate Director |
May 1, 2021 | ||
| W-2 Managing Employee |
May 1, 2021 | ||
| Phillips County Hospital |
5% Or Greater Direct Ownership Interest | Apr 1, 2015 | 100% |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Phillips County Health Systems |
Hospital | Other | Apr 1, 2015 |
| Phillips County Health Systems |
Hospital | Other | Apr 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/88f6f0ad-680b-460f-ba7c-9dd496dece04/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes | ||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100409050D | Medicaid | KS | |
| 100409050B | Medicaid | KS |
Other names
- d/b/a Phillips County Medical Clinic
Other providers in Phillipsburg, KS
- Phillips County
- Phillips County
- Phillips County
- Phillips County Health Department - Home Health Agency
- Phillips County Health Department-Home Health Agency
- Phillips County Hospital
- Phillips County Hospital
- Phillips County Hospital
- Phillips County Hospital
- Phillips County Hospital
All providers in Phillipsburg, 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 Dec 21, 2022. 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.