NPIMap

Organization Active NPI

Coffey County Hospital

  • Critical Access Hospital
  • Burlington, KS
National Provider Identifier
1376548370
Registry record updated Jan 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
COFFEY COUNTY HOSPITAL
Practice address
801 N 4TH
Burlington, KS 66839-2602
Phone
(620) 364-2121
Fax
(620) 364-4525
NPI assigned
Jun 16, 2005
Last updated
Jan 15, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2019

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

Authorized official

Name
Merri Michaels
Title
Billing Mananger
Phone
(620) 364-2121

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X KS
Critical Access Hospital 282NC0060X Primary
Certified Registered Nurse Anesthetist 367500000X KS

Addresses

Primary practice location

801 N 4TH
Burlington, KS 66839-2602

Mailing address

801 N 4TH St
Burlington, KS 66839-2602
Phone (620) 364-2121

Other identifiers 2

IdentifierTypeStateIssuer
100098820AMedicaidKS
180038OtherKSBLUE CROSS BLUE SHEILD

Other names 1

  • Coffey County Hospital Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170317000027 KS Part A Provider - Critical Access Hospital 4981598653 Receives reassigned benefits from 34 practitioners
Practice locations: Burlington, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376548370. Details of each certification follow.

Hospital certification: CCN 171385

Legal name
COFFEY COUNTY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 11, 2017
Last certification
Jul 11, 2017
Beds
25
Ownership / control type
Local
Organization structure
OtherNon-profit
Incorporated
in KS
Enrollment address
801 N 4TH St
Burlington, KS 66839-2602
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 6

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Coffey County HospitalCCN 171385 · All quality measures
Overall star rating
4 of 5
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • County of Coffey

    dba Coffey Co Health Dept

    • State or Local Public Health Clinic/Center
    • Burlington, KS
    • NPI 1285731406

    Member Of

    NPD member

Locations

1004 E Madison St
Yates Center, KS 66783
Phone (620) 625-2312

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Peter Allegre Individual Corporate DirectorSecretary of Board Jan 1, 2013
Perry Dale Chapman Individual Corporate DirectorBoard Treasurer Dec 19, 2022
Stacy Nicole Augustyn Individual Corporate OfficerCoo Jul 1, 2022
W-2 Managing Employee Jul 1, 2022
Jodi Lynn Thomas Individual Corporate DirectorBoard Member Jan 1, 2017
Michael Paul Abendroth Individual Corporate DirectorBoard Member Dec 27, 2023
Coffey County Hospital Organization, Burlington, KS Operational/Managerial Control Jan 1, 1966 100%
Stephen Craig Hopkins Individual Corporate Director Jan 1, 2014
Craig Howard Stukey Individual Corporate OfficerSenior Accountant Sep 4, 2018
W-2 Managing EmployeeSenior Accountant Sep 4, 2018
Eric Russell Ervin Individual Corporate Director Jan 2, 2024
Jeff Blair Clark Individual Corporate DirectorBoard Vice Chair Jan 1, 2016
County of Coffey Organization, Burlington, KS 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
John R Shell Individual Corporate OfficerChief Medical Officer Aug 1, 1993
W-2 Managing EmployeeCmo Jan 1, 2017 100%
Robert Melvin Fleming Individual Corporate DirectorBoard Member Jan 2, 2024
Arden Wayne Payer Individual Corporate DirectorBoard Member Jan 2, 2024

Owners & managing parties with NPI records 8

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
Coffey County HospitalBurlington, KS, CCN 17Z385 Hospital Other (100%) Jan 1, 2017
Coffey County Medical Center RHCBurlington, KS, CCN 173982 Rural health clinic 5% Or Greater Direct Ownership Interest (75%) Jan 1, 1966
Waverly Medical ClinicWaverly, KS, CCN 173983 Rural health clinic Operational/Managerial Control (100%) Apr 16, 1991
Yates Center Medical Center Rural Health ClinicYates Center, KS, CCN 178559 Rural health clinic Operational/Managerial Control (100%) Jul 18, 2018

Owned or controlled facilities with NPI records 4

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 37

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 37

Affiliated clinicians 90

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 90

NPI Registry JSON

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547510400000",
    "number": "1376548370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 N 4TH ST",
            "city": "BURLINGTON",
            "state": "KS",
            "postal_code": "668392602",
            "telephone_number": "620-364-2121",
            "fax_number": "620-364-8425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 N 4TH",
            "city": "BURLINGTON",
            "state": "KS",
            "postal_code": "668392602",
            "telephone_number": "620-364-2121",
            "fax_number": "620-364-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COFFEY COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-16",
        "last_updated": "2019-01-15",
        "status": "A",
        "authorized_official_last_name": "MICHAELS",
        "authorized_official_first_name": "MERRI",
        "authorized_official_title_or_position": "BILLING MANANGER",
        "authorized_official_telephone_number": "620-364-2121"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "KS",
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KS",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100098820A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "180038",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coffey County Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Coffey County Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Burlington, KS

Sources for this page

Verify at the official NPI Registry.