NPIMap

Organization Active NPI

Ascension Medical Group Via Christi, PA

  • Rural Health Clinic/Center
  • Mulvane, KS
National Provider Identifier
1437763463
Registry record updated Sep 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ASCENSION MEDICAL GROUP VIA CHRISTI, PA
Practice address
102 E Main St
Mulvane, KS 67110-1751
Phone
(316) 777-0106
Fax
(316) 777-4300
NPI assigned
Sep 8, 2020
Last updated
Sep 8, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2020

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

Authorized official

Name
Suzann Wright
Title
Director, Patient Financial Service
Phone
(316) 719-1201

Specialties & licenses 1

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

Addresses

Primary practice location

102 E Main St
Mulvane, KS 67110-1751

Mailing address

102 E Main St
Mulvane, KS 67110-1751
Phone (316) 777-0106

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210329002623 KS Part A Provider - Rural Health Clinic 2961314497 Practice locations: Mulvane, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437763463. Details of each certification follow.

Rural health clinic certification: CCN 173822

Legal name
ASCENSION MEDICAL GROUP VIA CHRISTI PA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 23, 1991
Last certification
Sep 23, 2009
Ownership / control type
1C
Most recent change of ownership
Sep 30, 2020 (1 total)
Organization structure
CorporationProprietary
Incorporated
in KS
Enrollment address
102 E Main St
Mulvane, KS 67110-1751

Other NPIs with the same Medicare PAC ID 2

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
17D0697749Ascension Medical Group Via Christ PA Mulvane102 E Main, Mulvane, KS 67110Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Via Christi Clinic PA5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Stephen W Hawks Individual Corporate OfficerBoard Member Jul 1, 2023
Abdel-Ghanie H Abu-Samra Individual Corporate OfficerBoard Member Sep 30, 2020
Morley Healy Individual Corporate OfficerBoard Member Jul 1, 2023
Brian Johnson Individual Corporate OfficerBoard Member Sep 30, 2020
Mark Wilkerson Individual Corporate OfficerAssistant Secretary Sep 30, 2020
Via Christi Clinical Services Organization, Wichita, KS Corporation Operational/Managerial Control Sep 30, 2020
Ann Buses Individual Corporate OfficerBoard Member Sep 30, 2020
Scott M Hane Individual Corporate OfficerBoard Member Sep 30, 2020
Terri D Walton Individual Corporate OfficerBoard Member Sep 30, 2020
Terri a Nickel Individual Corporate OfficerBoard Member Jul 1, 2023
Philip Newlin Individual 5% Or Greater Direct Ownership InterestBoard Member Sep 30, 2020 100%
Corporate Officer Sep 30, 2020
VCH Iowa Organization, Des Moines, IA Corporation 5% Or Greater Direct Ownership Interest Sep 30, 2020 100%
Andre Saad Individual Corporate OfficerBoard Member Jul 1, 2023
Kyle B Vincent Individual Corporate OfficerBoard Member Sep 30, 2020
Stephanie Shaffer Individual W-2 Managing EmployeeManager Sep 30, 2020

Owners & managing parties with NPI records 9

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

Facilities with the same owner 1

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

Change-of-ownership history 1

DateEventCounterparty
Sep 30, 2020 Change of OwnershipThis provider was the buyer Sumner County Family Care Center PACCN 173822, KS, NPI 1336269638

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1437763463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 E MAIN ST",
            "city": "MULVANE",
            "state": "KS",
            "postal_code": "671101751",
            "telephone_number": "316-777-0106",
            "fax_number": "316-777-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E MAIN ST",
            "city": "MULVANE",
            "state": "KS",
            "postal_code": "671101751",
            "telephone_number": "316-777-0106",
            "fax_number": "316-777-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASCENSION MEDICAL GROUP VIA CHRISTI, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-08",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "SUZANN",
        "authorized_official_title_or_position": "DIRECTOR, PATIENT FINANCIAL SERVICE",
        "authorized_official_telephone_number": "316-719-1201"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mulvane, KS

Sources for this page

Verify at the official NPI Registry.