NPIMap

Organization Active NPI

Stafford County Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Stafford, KS
National Provider Identifier
1437258779
Registry record updated Feb 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
H-093-002 Issued in KS
Legal business name
STAFFORD COUNTY HOSPITAL
Practice address
502 South Buckeye Street
Stafford, KS 67578-0190
Phone
(620) 234-5221
Fax
(620) 234-5792
NPI assigned
Sep 22, 2006
Last updated
Feb 12, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2009

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

Authorized official

Name
Janell Goodno
Title
Cfo
Phone
(620) 234-5221

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X H-093-002 KS Primary

Addresses

Primary practice location

502 South Buckeye Street
Stafford, KS 67578-0190

Mailing address

502 South Buckeye Street
Stafford, KS 67578-0190
Phone (620) 234-5221

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070228000176 KS Part A Provider - Critical Access Hospital 3678583382 Practice locations: Stafford, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437258779. Details of each certification follow.

Hospital certification: CCN 17Z323

Legal name
STAFFORD COUNTY HOSPITAL
Organization structure
GovernmentNon-profit
Enrollment address
502 S Buckeye St
Stafford, KS 67578-2035
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Tracy Fanshier Individual Corporate Director Jan 1, 2012
Stafford County Hospital Organization, Stafford, KS Non-profit Operational/Managerial Control Dec 1, 2011
Mary Hildebrand Individual Corporate Director Apr 26, 2006
Boyd Volker Individual Corporate DirectorBoard Member Jan 1, 2012
Ruth Teichman Individual Corporate Director Mar 18, 2013
Todd S Taylor Individual Corporate OfficerAdministrator Jun 1, 2012
W-2 Managing EmployeeAdministrator Jun 1, 2012
Jo R Caley Individual Corporate OfficerAssistant Administrator Jun 1, 2012
W-2 Managing EmployeeAssistant Administrator Jun 1, 2012

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 5

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

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234396800000",
    "number": "1437258779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 SOUTH BUCKEYE STREET",
            "city": "STAFFORD",
            "state": "KS",
            "postal_code": "675780190",
            "telephone_number": "620-234-5221",
            "fax_number": "620-234-5792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 SOUTH BUCKEYE STREET",
            "city": "STAFFORD",
            "state": "KS",
            "postal_code": "675780190",
            "telephone_number": "620-234-5221",
            "fax_number": "620-234-5792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAFFORD COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2009-02-12",
        "status": "A",
        "authorized_official_last_name": "GOODNO",
        "authorized_official_first_name": "JANELL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "620-234-5221"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "KS",
            "license": "H-093-002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stafford, KS

Sources for this page

Verify at the official NPI Registry.