NPIMap

Organization Active NPI

Great Plains of Cheyenne Co Inc

Doing business as Cheyenne County Clinic

  • Rural Health Clinic/Center
  • Bird City, KS
National Provider Identifier
1417988932
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GREAT PLAINS OF CHEYENNE CO INC
Doing business as
Cheyenne County Clinic
Practice address
221 W Fourth Street
Bird City, KS 67731
Phone
(785) 734-2306
Fax
(785) 734-2233
NPI assigned
Jul 5, 2006
Last updated
Feb 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

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

Authorized official

Name
Jeremy Michael Clingenpeel
Title
Ceo
Phone
(785) 332-2104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

221 W Fourth Street
Bird City, KS 67731

Mailing address

221 W Fourth Street
Bird City, KS 67731-0211
Phone (785) 734-2306

Other identifiers 2

IdentifierTypeStateIssuer
30003937290002MedicaidKS
110731OtherBCBS

Other names 1

  • Cheyenne County Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060404000643 KS Part A Provider - Rural Health Clinic 7517958523 Practice locations: Bird City, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417988932. Details of each certification follow.

Rural health clinic certification: CCN 173478

Legal name
GREAT PLAINS OF CHEYENNE CO INC
Doing business as
CHEYENNE COUNTY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 27, 1998
Last certification
Nov 13, 2013
Ownership / control type
2B
Most recent change of ownership
Jan 1, 2002 (1 total)
Organization structure
CorporationNon-profit
Incorporated
in KS
Enrollment address
221 W 4TH
Bird City, KS 67731
Related CCNs
171310

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

Other NPIs with the same Medicare PAC ID 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D0937889Cheyenne County Clinic-Bird City221 West Fourth, Bird City, KS 67731Certificate of waiverDec 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Great Plains of Cheyenne County Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
John Terrill Individual Corporate DirectorBoard Member Sep 18, 2007 5%
William Wilger Individual Corporate DirectorBoard Member Jul 1, 2021
Ryan Murray Individual Corporate DirectorBoard Member Jul 1, 2021
Sondra Bracelin Individual Corporate DirectorBoard Member Jul 1, 2021
Teresa Moore Individual Corporate DirectorBoard Member Jul 1, 2021
Great Plains Health Alliance Inc Organization, Phillipsburg, KS Operational/Managerial Control Jan 1, 2002
Steve L Carlson Individual Corporate OfficerChairman of the Board May 24, 1994 20%
Corporate DirectorChairman of the Board May 24, 1988 20%
Barbara a Brown Applegate Individual Corporate Director Sep 20, 2011
Heidi Tice Individual Corporate OfficerCfo Apr 1, 1998
Operational/Managerial ControlCfo Jan 20, 2017
Arthur G Henrickson Individual Corporate DirectorBoard Member Jun 19, 2017
Leslie C Lacy Individual Corporate OfficerVice President Oct 1, 2012
W-2 Managing EmployeeVice President Oct 1, 2012
Jeremy M Clingenpeel Individual Corporate OfficerCeo Jan 30, 2023
Corporate DirectorCeo Jan 30, 2023
W-2 Managing EmployeeCeo Jan 30, 2023
Curt Colson Individual Corporate DirectorPres of Great Plains Health Alli Apr 1, 2022

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1417988932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 W FOURTH STREET",
            "city": "BIRD CITY",
            "state": "KS",
            "postal_code": "677310211",
            "telephone_number": "785-734-2306",
            "fax_number": "785-734-2233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 W FOURTH STREET",
            "city": "BIRD CITY",
            "state": "KS",
            "postal_code": "67731",
            "telephone_number": "785-734-2306",
            "fax_number": "785-734-2233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT PLAINS OF CHEYENNE CO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "CLINGENPEEL",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "785-332-2104"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30003937290002",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "110731",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cheyenne County Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cheyenne County Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bird City, KS

Sources for this page

Verify at the official NPI Registry.