Jewell County Hospital
Organization Active NPI Rural Health Clinic/Center · Mankato, KS
NPI 1386689586 · NPPES record last updated Jun 26, 2024
Key facts
- NPI
- 1386689586
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- H045001 (KS)
- Legal business name
- JEWELL COUNTY HOSPITAL
- Practice address
- 100 Crestvue Ave
Mankato, KS 66956-2407 - Phone
- (785) 378-3137
- Fax
- (785) 378-3450
- NPI assigned
- Jun 19, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- JEWELL COUNTY HOSPITAL
Authorized official
- Name
- Barry Bottger
- Title
- Cfo
- Phone
- (785) 378-3137
Owners & managing parties with NPI records 2
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 2
Member of 1
Related certifications (CCN) 1
Facilities with the same owner 2
Practitioners 9
-
Marilyn Dunstan, ARNP
-
Bryan K Houchens, PA-C
-
Rebecca Snyder, PA
-
Andy Edward Walker, M.D.
-
Dawn A Steinman, APRN
-
Dennis L Sewell, PA-C
-
Nolan Jackson Beavers, M.D,
-
Cayle L Goertzen, MD
-
Danilo Joson Calderon, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D0450841 | Jewell County Rural Health Clinic | Provider-performed microscopy | Jul 19, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KS
Rural health clinic certification: CCN 173479
- Legal name
- JEWELL COUNTY HOSPITAL
- Doing business as
- JEWELL COUNTY RURAL HEALTH CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jun 20, 1998
- Last certification
- Jan 12, 2016
- Ownership / control type
- Non-profit – church related
- Organization structure
- Other · Non-profit
- Enrollment address
- 100 Crestvue Ave
Mankato, KS 66956-2407 - Related CCNs
- 171309
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Barry Kent Bottger |
Corporate Officer |
Jan 1, 2014 | 30% |
| W-2 Managing Employee |
Jan 1, 2015 | 30% | |
| Doyle L McKimmy |
Corporate Director | May 21, 2007 | |
| Elizabeth McKain |
Corporate Director |
Jan 1, 2023 | |
| W-2 Managing Employee |
Jan 1, 2023 | ||
| D'Ann Gardner |
W-2 Managing Employee |
Jan 1, 2023 | |
| County of Jewell |
5% Or Greater Direct Ownership Interest | Nov 1, 1967 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030904000028 | KS | Part a Provider - Rural Health Clinic | 7911818273 | Practice locations: Mankato, KS |
| O20040317000997 | KS | Part B Supplier - Clinic/Group Practice | 7911818273 |
Receives reassigned benefits from 6 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Mankato, KS |
National Provider Directory
- Part of
- Jewell Co Rural Health
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | H045001 | KS | Yes |
Addresses
Primary practice location
100 Crestvue Ave
Mankato, KS 66956-2407
Mailing address
100 Crestvue Ave
Mankato, KS 66956-2407
Phone (785) 378-3137
Other names
- Jewell County Rural Health Clinic
Other providers in Mankato, KS
- Lyle R Dauner
- Marilyn Dunstan
- Tammy Frost
- John T Groom
- Jewell County Hospital
- Jewell County Hospital
- Jewell County Hospital
- Jewell County Hospital LTC
- Usd 107
All providers in Mankato, 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 Jun 26, 2024. 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.