NPIMap

Organization Active NPI

Wamego Hospital Association

  • Rural Health Clinic/Center
  • Wamego, KS
National Provider Identifier
1437215480
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H-075-002 Issued in KS
Legal business name
WAMEGO HOSPITAL ASSOCIATION
Practice address
711 Genn Dr
Wamego, KS 66547
Phone
(785) 456-2295
Fax
(785) 456-9467
NPI assigned
Dec 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Authorized official

Name
Steve Land
Title
Administrator
Phone
(785) 456-2295

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X H-075-002 KS Primary

Addresses

Primary practice location

711 Genn Dr
Wamego, KS 66547

Mailing address

711 Genn Dr
Wamego, KS 66547-1179
Phone (785) 456-2295

Other identifiers 2

IdentifierTypeStateIssuer
100420870-CMedicaidKS
001537-RHCOtherKSBLUE CROSS

Other names 1

  • Wamego Family Clinic & Wamego Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030731000013 KS Part A Provider - Rural Health Clinic 5395656086 Practice locations: Wamego, KS

Other NPIs with the same Medicare PAC ID 2

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

Rural health clinic certification: CCN 178510

Legal name
WAMEGO HOSPITAL ASSOCIATION
Doing business as
WAMEGO FAMILY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 16, 2003
Last certification
May 19, 2010
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 7, 2002 in KS
Enrollment address
711 Genn Dr
Wamego, KS 66547-1179
Related CCNs
171337

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

National Provider Directory

National Provider Directory
Tax ID family
Wamego Hospital Association3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Member of 1

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

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
Robert Copple Individual Corporate OfficerSenior Administrator May 23, 2016 51%
Corporate DirectorSenior Administrator May 23, 2016 51%
W-2 Managing EmployeeSenior Administrator May 23, 2016 51%
Operational/Managerial ControlSenior Administrator May 23, 2016 51%
Ascension Via Christi Hospital Manhattan Inc Organization, Manhattan, KS Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2002 51%
Dwight Faulkner Individual Corporate OfficerBoard Member May 3, 2018 49%
Mark Wilkerson Individual Corporate Director Jan 1, 2019
Brian Howells Individual Corporate OfficerBoard Member May 3, 2018 49%
Segen Elizabeth S Chase Individual Corporate Officer Jul 1, 2021
Lanny Bosse Individual Corporate OfficerBoard Member May 3, 2018 49%
Michael McCullough Individual Corporate Director Jan 1, 2019
Thomas Beem Individual Corporate Director Jan 1, 2019
Dirk Daveline Individual Corporate Director Jan 1, 2019
Ryan Jennings Kueker Individual Corporate Officer Jul 1, 2021
City of Wamego Organization, Wamego, KS 5% Or Greater Direct Ownership Interest Jul 1, 2002 49%
Jennifer Goehring Individual Corporate Director Jan 1, 2019
Stephanie Shaffer Individual W-2 Managing Employee Jul 1, 2021

Owners & managing parties with NPI records 5

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

Facilities with the same owner 2

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

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1437215480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 GENN DR",
            "city": "WAMEGO",
            "state": "KS",
            "postal_code": "665471179",
            "telephone_number": "785-456-2295",
            "fax_number": "785-456-9467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 GENN DR",
            "city": "WAMEGO",
            "state": "KS",
            "postal_code": "66547",
            "telephone_number": "785-456-2295",
            "fax_number": "785-456-9467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAMEGO HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "LAND",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "785-456-2295"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KS",
            "license": "H-075-002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100420870-C",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "001537-RHC",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wamego Family Clinic & Wamego Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wamego, KS

Sources for this page

Verify at the official NPI Registry.