Konza Prairie Community Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Chapman, KS
NPI 1396459293 · NPPES record last updated Jun 3, 2025
Key facts
- NPI
- 1396459293
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- KONZA PRAIRIE COMMUNITY HEALTH CENTER, INC.
- Practice address
- 111 E 5TH St
Chapman, KS 67431-2517 - Phone
- (785) 238-4711
- Fax
- (785) 530-6150
- NPI assigned
- Jan 6, 2023
- Organization subpart
- Yes
- Parent organization (as reported)
- KONZA PRAIRIE COMMUNITY HEALTH CENTER, INC.
Authorized official
- Name
- Danielle Hallgren
- Title
- Ceo
- Phone
- (785) 238-4711
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 1
-
Dustie Angela Samuels, D.O.
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Practitioners 22
-
Jennifer Pearl Ebert, FNP
-
Todd A Frieze, MD
-
Nicole Gonzalez, LCMFT
-
Kelley Ann Herron, APRN
-
Andrea Laurin McFarland, LSCSW
-
Melody Anne Morse, MSN, APRN, PMHNP-BC
-
Shana Christine Roether, FNP-BC
-
Dustie Angela Samuels, D.O.
-
Heather Ann Sloan, FNP-BC
-
Daniel M. Winter, D.D.S.
-
Cshandar A Lamb, PA
-
Swathi Punreddy, PA
-
Tracy L B Sabo, RDN
-
Amanda Folsom, PMHNP
-
Michaela Marie Wik, LCSW
-
Kalie May Kipp, RDN
-
Taylor Pratt, DMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D1001899 | Konza Prairie Community Health Center, Inc | Certificate of waiver | Jul 22, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KS
Federally qualified health center certification: CCN 171037
- Legal name
- KONZA PRAIRIE COMMUNITY HEALTH CENTER INC
- Doing business as
- KONZA PRAIRIE COMMUNITY HEALTH CENTER CHAPMAN CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 9, 2023
- Last certification
- Jan 9, 2023
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 111 E 5TH St
Chapman, KS 67431-2517
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Paula Pedersen |
W-2 Managing Employee |
Jan 3, 2022 | |
| Lisa Osbourn |
Corporate Director |
Dec 1, 2010 | |
| Margaret Kilpatrick |
Corporate Director |
Feb 1, 2022 | |
| Vicky D. Minton |
Corporate Officer |
Jan 1, 2024 | |
| W-2 Managing Employee |
Jan 1, 2024 | ||
| Operational/Managerial Control |
Jan 1, 2024 | ||
| Gene Parrish |
Corporate Director |
May 1, 2009 | |
| Danielle Hallgren |
Corporate Officer |
Dec 16, 2022 | |
| W-2 Managing Employee |
Dec 16, 2022 | ||
| Susan Adamchak |
Corporate Director |
Jul 1, 2023 | |
| Aaron Estabrook |
Corporate Director |
Mar 1, 2020 | |
| Irene Portillo |
Contracted Managing Employee |
Jun 17, 2024 | |
| Tom Brungardt |
Corporate Director |
Mar 1, 2013 | |
| Carol Lawson |
Corporate Director |
Jul 1, 2023 | |
| Florence C. Whitebread |
Corporate Director |
Nov 1, 1994 | |
| Dustie Angela Samuels |
W-2 Managing Employee |
Mar 4, 2024 | |
| Myron Coryell |
Corporate Director |
May 1, 1999 | |
| Leann Kooken |
Corporate Officer |
Feb 6, 2023 | |
| W-2 Managing Employee |
Feb 6, 2023 | ||
| Operational/Managerial Control |
Feb 6, 2023 | ||
| Lawrence P. Palmer |
Corporate Director |
Jan 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040109000751 | KS | Part B Supplier - Clinic/Group Practice | 3779483466 |
Receives reassigned benefits from 21 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Junction City, KS; Manhattan, KS; Chapman, KS |
| O20230123001865 | KS | Part a Provider - Federally Qualified Health Center (FQHC) | 3779483466 | Practice locations: Chapman, KS |
National Provider Directory
- Tax ID family
- Konza Prairie Community
- Part of
- Konza Prairie Community
Locations
102 N Eisenhower Dr
Junction City, KS 66441
Phone (785) 238-4711
222 N 6th St
Ste 100
Manhattan, KS 66502
Phone (785) 320-7134
2030 Tecumseh Rd
Ste 100
Manhattan, KS 66502
Phone (785) 320-7134
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JAFCAD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
111 E 5TH St
Chapman, KS 67431-2517
Mailing address
361 Grant Ave
Junction City, KS 66441-4201
Phone (785) 238-4711
Other names
- Konza Prairie Community Health Center Chapman Clinic
Other providers in Chapman, KS
All providers in Chapman, KS · Federally Qualified Health Center (FQHC) 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 3, 2025. 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.