Augusta Family Practice, PA
Organization Active NPI Rural Health Clinic/Center · Augusta, KS
NPI 1508060864 · NPPES record last updated Oct 26, 2022
Key facts
- NPI
- 1508060864
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 17D0970229 (KS)
- Legal business name
- AUGUSTA FAMILY PRACTICE, PA
- Practice address
- 1306 State St
Augusta, KS 67010-1126 - Phone
- (316) 775-9191
- Fax
- (316) 775-0348
- NPI assigned
- Jun 12, 2007
- Organization subpart
- No
Authorized official
- Name
- Lynette Scheid
- Title
- Clinic Administrator
- Phone
- (316) 201-6711
Owners & managing parties with NPI records 2
-
Michael A Rausch, M.D.
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Practitioners 15
-
Jennifer Lynne Dutton, PA-C
-
Grayce Kaufmann, APRN
-
Michael A Rausch, M.D.
-
Elizabeth Ann Warman, PA-C
-
Christie Gannon, FNP-C
-
Michael James Manley, FNP-BC
-
Andrea K Babb, PA-C
-
Lauren McMullen, PA-C
-
Todd Peters, MD
-
Edna Karleen Smith, ARNP
-
Keri J Wehling, PA-C
-
Lisa M Wiebe, APRN
-
Ashley N. Winblad, A.P.R.N.
-
Lela J. Goatley, ARNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KS
Rural health clinic certification: CCN 178951
- Legal name
- AUGUSTA FAMILY PRACTICE, PA
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Nov 3, 1999
- Last certification
- Dec 27, 2013
- Ownership / control type
- 1B
- Organization structure
- Corporation · Proprietary
- Enrollment address
- 1306 State St
Augusta, KS 67010-1126
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Augusta Family Practice, PA |
5% Or Greater Direct Ownership Interest | Nov 3, 1999 | 100% |
| Operational/Managerial Control | Nov 3, 1999 | 100% | |
| Lynette Scheid |
W-2 Managing Employee | Jan 1, 2024 | |
| Operational/Managerial Control |
Jan 2, 2010 | 80% | |
| Michael a Rausch |
5% Or Greater Direct Ownership Interest |
Sep 1, 2010 | 100% |
| W-2 Managing Employee | Nov 3, 1999 | ||
| Amanda Johnson |
W-2 Managing Employee |
Jan 1, 2024 | 90% |
| Operational/Managerial Control |
Nov 4, 2010 | 20% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050426001028 | KS | Part B Supplier - Clinic/Group Practice | 4284673641 |
Receives reassigned benefits from 6 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Augusta, KS |
| O20101008000983 | KS | Part a Provider - Rural Health Clinic | 4284673641 | Practice locations: Augusta, KS |
National Provider Directory
- Tax ID family
- Augusta Family Practice
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 17D0970229 | KS | Yes |
Addresses
Primary practice location
1306 State St
Augusta, KS 67010-1126
Mailing address
1306 State St
Augusta, KS 67010-1126
Phone (316) 775-9191
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100359330B | Medicaid | KS |
Other names
- AUGUSTA RURAL HEALTH CLINIC
Other providers in Augusta, KS
- Annette Louise Athy
- Augusta Chiropractic Health Center, Inc.
- Augusta Family Chiropractic, Inc.
- Augusta Family Denistry PA
- Augusta Family Practice
- Augusta Family Practice, PA
- Authentic Living Counseling
- Charles Stewart Bacon
- Caralyn Bailey
- Caleb Barnes
All providers in Augusta, KS · Rural Health Clinic/Center in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.