NPIMap

Organization Active NPI

Rural Health Resources of Jackson Co Inc

Doing business as Family Practice Associates

  • Rural Health Clinic/Center
  • Holton, KS
National Provider Identifier
1639145204
Registry record updated Nov 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H-043-001 Issued in KS
Legal business name
RURAL HEALTH RESOURCES OF JACKSON CO INC
Doing business as
Family Practice Associates
Holton Family Medicine
Practice address
1110 Columbine Dr Ste 100
Holton, KS 66436-8824
Phone
(785) 364-2126
Fax
(785) 364-2801
NPI assigned
Feb 24, 2006
Last updated
Nov 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2023

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

Authorized official

Name
Ms. Carrie L Saia
Title
Chief Executive Officer
Phone
(785) 364-2116

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X KS
Rural Health Clinic/Center 261QR1300X H-043-001 KS Primary

Addresses

Primary practice location

1110 Columbine Dr Ste 100
Holton, KS 66436-8824

Mailing address

1110 Columbine Dr Ste 100
Holton, KS 66436-8824
Phone (785) 364-2126

Other identifiers 3

IdentifierTypeStateIssuer
100244350BMedicaidKS
100244350EMedicaidKS
110707OtherKSBLUE CORSS GROUP PROVIDER

Other names 2

  • Family Practice Associates Doing business as
  • Holton Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20030505000059 KS Part A Provider - Rural Health Clinic 7810807690 Practice locations: Holton, KS
O20031111000573 KS Part B Supplier - Clinic/Group Practice 7810807690 Receives reassigned benefits from 55 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Holton, KS
O20040401001705 KS Part A Provider - Rural Health Clinic 7810807690 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hoyt, KS

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1639145204. Details of each certification follow.

Rural health clinic certification: CCN 178511

Legal name
RURAL HEALTH RESOURCES OF JACKSON CO INC
Doing business as
HOLTON FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 3, 2003
Last certification
Oct 26, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
1110 Columbine Dr
Ste 100
Holton, KS 66436-8824
Related CCNs
171319

Rural health clinic certification: CCN 178523

Legal name
RURAL HEALTH RESOURCES OF JACKSON CO INC
Doing business as
HOYT FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 2, 2004
Last certification
Aug 31, 2010
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 17, 1997 in KS
Enrollment address
117 W 3Rd St
Hoyt, KS 66440-9671
Related CCNs
171319

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

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
17D1019177Holton Family Medicine1110 Columbine Drive, Suite 100, Holton, KS 66436Certificate of waiverNov 11, 2027

National Provider Directory

National Provider Directory

Locations

1110 Columbine Dr
Ste 100
Holton, KS 66436
Phone (785) 364-2126

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Marilyn Watkins Individual Corporate Director Jan 1, 2021
Daniel Allen Brenner Individual Corporate OfficerVice Chair - Board of Directors Oct 23, 2018
Corporate Director Sep 25, 2013
Chad Bontrager Individual Corporate Director Oct 23, 2018
Bobbi J Ambrosio Individual Corporate Director Jul 1, 2021
Mark Aeschliman Individual Corporate Director Oct 23, 2018
Ladona M Schmidt Individual Corporate Director Jul 22, 2021
Carrie L Lutz Individual Corporate OfficerCeo Sep 26, 2012
W-2 Managing EmployeeCeo Jun 1, 2015
Operational/Managerial ControlChief Executive Officer Sep 26, 2012 100%
Operational/Managerial ControlChief Executive Officer Sep 26, 2012
Heather Schrick Individual Corporate Director Sep 25, 2019
Rural Health Resources of Jackson Co Inc Organization, Holton, KS Non-profit 5% Or Greater Direct Ownership Interest Nov 3, 2003 100%
5% Or Greater Direct Ownership Interest Apr 17, 1997 100%
Operational/Managerial Control Apr 17, 1997 100%
Gloria Stavropoulos Individual Corporate Director Sep 25, 2019

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Holton Community HospitalHolton, KS, CCN 171319 Hospital Operational/Managerial Control Apr 17, 1997
Holton Community HospitalHolton, KS, CCN 17Z319 Hospital Operational/Managerial Control Sep 26, 2012
Holton Community Hospital Home Health and Hospice AgencyHolton, KS, CCN 177272 Home health agency Operational/Managerial Control (100%) Apr 17, 1997
Rural Health Resources of Jackson Co IncHolton, KS, CCN 171544 Hospice Operational/Managerial Control (100%) Apr 17, 1997
Hoyt Family MedicineHoyt, KS, CCN 178523 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 17, 1997
Apr 17, 1997
Wetmore Family MedicineWetmore, KS, CCN 178575 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2013
Jan 1, 2013

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Practitioners 90

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 90

NPI Registry JSON

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699228800000",
    "number": "1639145204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 COLUMBINE DR STE 100",
            "city": "HOLTON",
            "state": "KS",
            "postal_code": "664368824",
            "telephone_number": "785-364-2126",
            "fax_number": "785-364-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 COLUMBINE DR STE 100",
            "city": "HOLTON",
            "state": "KS",
            "postal_code": "664368824",
            "telephone_number": "785-364-2126",
            "fax_number": "785-364-2801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH RESOURCES OF JACKSON CO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-24",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A",
        "authorized_official_last_name": "SAIA",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "785-364-2116",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KS",
            "license": "H-043-001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100244350B",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100244350E",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CORSS GROUP PROVIDER",
            "identifier": "110707",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Practice Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Practice Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Holton Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holton, KS

Sources for this page

Verify at the official NPI Registry.