NPIMap

Organization Active NPI

Wilson County Hospital

Doing business as Neodesha Family Medicine

  • Rural Health Clinic/Center
  • Neodesha, KS
National Provider Identifier
1639699309
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H103002 Issued in KS
Legal business name
WILSON COUNTY HOSPITAL
Doing business as
Neodesha Family Medicine
Practice address
2600 Ottawa Rd Ste 101
Neodesha, KS 66757-1897
Phone
(620) 325-2622
Fax
(620) 325-5380
NPI assigned
Jun 23, 2017
Last updated
Sep 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Authorized official

Name
Lori C Smith
Title
Cfo
Phone
(620) 325-8388

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X H103002 KS Primary

Addresses

Primary practice location

2600 Ottawa Rd Ste 101
Neodesha, KS 66757-1897

Mailing address

PO Box 360
Neodesha, KS 66757-0360
Phone (620) 325-2611

Other names 1

  • Neodesha Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041119000995 KS Part B Supplier - Clinic/Group Practice 0042273971 Receives reassigned benefits from 22 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cherryvale, KS; Independence, KS; Neodesha, KS
O20170918002281 KS Part A Provider - Rural Health Clinic 0042273971 Practice locations: Neodesha, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639699309. Details of each certification follow.

Rural health clinic certification: CCN 178610

Legal name
WILSON COUNTY HOSPITAL
Doing business as
NEODESHA FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 29, 2017
Last certification
Dec 29, 2017
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
2600 Ottawa Rd
Ste 101
Neodesha, KS 66757-1897
Related CCNs
171344

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

Other NPIs with the same Medicare PAC ID 3

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.

National Provider Directory

National Provider Directory

Locations

209 N 6th St
Ste 103
Independence, KS 67301
Phone (620) 331-2400

2600 Ottawa Rd
#360
Neodesha, KS 66757
Phone (620) 325-8336

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Wilson County Hospital Organization, Neodesha, KS 5% Or Greater Direct Ownership Interest Jul 1, 2017 100%
WM C Estes Individual Corporate DirectorBoard President Jun 1, 2013 5%
Drew Johnson Individual Corporate DirectorBoard Member Feb 1, 2014 5%
Lori C Smith Individual W-2 Managing EmployeeCfo Oct 8, 2020
Amy Brown Individual Corporate DirectorBoard Member Aug 1, 2001 5%
Bert Chronister Individual Corporate DirectorBoard Treasurer Aug 1, 1997 5%
Operational/Managerial ControlMedical Director Jul 1, 2017 5%
Justin Newland Individual Corporate DirectorBoard Member Mar 1, 2020
Julie Lair Individual Corporate DirectorBoard Secretary May 1, 2011 5%
Michael Springer Individual Corporate DirectorBoard Member Aug 1, 2015 5%

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Independence Family MedicineIndependence, KS, CCN 178582 Rural health clinic Operational/Managerial Control May 20, 2013

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1498176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727222400000",
    "number": "1639699309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 360",
            "city": "NEODESHA",
            "state": "KS",
            "postal_code": "667570360",
            "telephone_number": "620-325-2611",
            "fax_number": "620-325-8453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 OTTAWA RD STE 101",
            "city": "NEODESHA",
            "state": "KS",
            "postal_code": "667571897",
            "telephone_number": "620-325-2622",
            "fax_number": "620-325-5380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-23",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "620-325-8388"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KS",
            "license": "H103002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Neodesha Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Neodesha, KS

Sources for this page

Verify at the official NPI Registry.