Healthback Home Health of Kansas, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

A087041 Issued in KS

Legal business name

HEALTHBACK HOME HEALTH OF KANSAS, INC.

Practice address

1117 South Rock Road
Suite 3
Wichita, KS 67207-3355

Phone

(316) 687-0340

Fax

(316) 687-0184

NPI assigned

Apr 15, 2011

Last updated

Dec 9, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Troy L. Ayers

Title

Chief Financial Officer

Phone

(405) 842-1700

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366732950. Details of each certification follow.

• CCN 178078 Home health agency · Active · Details

Home health agency certification: CCN 178078

Legal name

HEALTHBACK HOME HEALTH OF KANSAS, INC.

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Aug 20, 2008

Last certification

Oct 20, 2008

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Mar 18, 2011 in KS

Enrollment address

1117 S Rock Rd
Ste 3
Wichita, KS 67207-3355

Listed as

Tradition HealthCCN 178078 · All quality measures

Ownership

Proprietary

Certified

Aug 20, 2008

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Locations

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.

Facilities with the same owner 1

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

• Healthback of Central Oklahoma, Inc.

  dba HealthBack Home Health of Ponca City

  • Home Health Agency
  • Ponca City, OK
  • NPI 1750545554

  Healthback Holdings, LLC, Wilson Ayers Trust, Wilson Evans Trust

  CMS ownership

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

{
    "created_epoch": "1302825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607472000000",
    "number": "1366732950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16211 N MAY AVE",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730138871",
            "telephone_number": "405-842-1700",
            "fax_number": "405-767-1695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1117 SOUTH ROCK ROAD",
            "address_2": "SUITE 3",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672073355",
            "telephone_number": "316-687-0340",
            "fax_number": "316-687-0184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHBACK HOME HEALTH OF KANSAS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-15",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A",
        "authorized_official_last_name": "AYERS",
        "authorized_official_first_name": "TROY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "405-842-1700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "KS",
            "license": "A087041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200842680A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Wichita, KS
• Providers in Wichita, KS by specialty
• Home Health Agency in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.