Ninnescah Valley Health Systems Inc
Organization Active NPI Rural Health Clinic/Center · Kingman, KS
NPI 1508253501 · NPPES record last updated Sep 3, 2025
Key facts
- NPI
- 1508253501
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- NINNESCAH VALLEY HEALTH SYSTEMS INC
- Practice address
- 750 W D Ave
Kingman, KS 67068-1266 - Phone
- (620) 532-0295
- Fax
- (855) 483-0002
- NPI assigned
- Apr 17, 2015
- Organization subpart
- No
Authorized official
- Name
- Lacy Drosselmeyer
- Title
- Compliance Specialist
- Phone
- (620) 532-0281
Owners & managing parties with NPI records 4
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 4
Related certifications (CCN) 1
Facilities with the same owner 1
Practitioners 12
-
Tyler J Antenen, P.A.-C
-
Erin M Baxa, MD
-
Jessica Blackwill, APRN
-
Joseph Gerber, MD
-
Logan Leigh Hageman, APRN
-
Dennis Kalmar, PA-C
-
Amy Renee Miller, APRN
-
Sarah R Kinderknecht, APRN
-
Jo Anne Berry, P.A.-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KS
Rural health clinic certification: CCN 178588
- Legal name
- NINNESCAH VALLEY HEALTH SYSTEMS INC
- Doing business as
- KINGMAN HEALTHCARE CENTER FAMILY CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 1, 2015
- Last certification
- Dec 12, 2018
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 6, 1968 in KS
- Enrollment address
- 750 W D Ave
Kingman, KS 67068-1266 - Related CCNs
- 171378
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Thad Turner |
Corporate Director |
Mar 1, 2018 | |
| W-2 Managing Employee |
Mar 1, 2018 | ||
| Operational/Managerial Control |
Mar 1, 2018 | ||
| Preston M Sauers |
Corporate Officer |
Apr 21, 2021 | |
| W-2 Managing Employee |
Apr 21, 2021 | ||
| Operational/Managerial Control |
Apr 21, 2021 | ||
| Ninnescah Valley Health Systems Inc |
5% Or Greater Direct Ownership Interest | Mar 27, 2015 | 100% |
| Lacy Drosselmeyer |
Corporate Director |
Aug 1, 2016 | |
| W-2 Managing Employee |
Aug 1, 2016 | ||
| Operational/Managerial Control |
Aug 1, 2016 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Cunningham Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | May 6, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040407000038 | KS | Part B Supplier - Clinic/Group Practice | 5799683694 |
Receives reassigned benefits from 41 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cunningham, KS; Kingman, KS |
| O20150505000953 | KS | Part a Provider - Rural Health Clinic | 5799683694 |
Receives reassigned benefits from 1 practitioner Practice locations: Kingman, KS |
National Provider Directory
Locations
750 W D Ave
Kingman, KS 67068
Phone (620) 532-0295
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
750 W D Ave
Kingman, KS 67068-1266
Mailing address
750 W D Ave
Kingman, KS 67068-1266
Phone (620) 532-0295
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30003916630006 | Medicaid | KS |
Other names
- KINGMAN HEALTHCARE CENTER FAMILY CLINIC
Other providers in Kingman, KS
- Merlin McFarland
- Valerie Sue Meadows
- Victoria M Moots
- Cherie Louise Morris
- New Counseling & Support Services
- Ninnescah Valley Health Systems, Inc.
- Ninnescah Valley Health Systems, Inc.
- Ninnescah Valley Health Systems, Inc.
- Onyx Enterprises Inc.
- Megan Ann Osner
All providers in Kingman, 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 Sep 3, 2025. 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.