NPIMap

Organization Active NPI

Gracemed Health Clinic, Inc

Doing business as GraceMed Good Samaritan Clinic

  • Federally Qualified Health Center (FQHC)
  • Wichita, KS
National Provider Identifier
1659631695
Registry record updated Sep 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GRACEMED HEALTH CLINIC, INC
Doing business as
GraceMed Good Samaritan Clinic
Practice address
3701 E 13TH St N
Wichita, KS 67208-2086
Phone
(316) 866-2000
Fax
(316) 866-2084
NPI assigned
May 24, 2012
Last updated
Sep 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2025

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

Authorized official

Name
Julie Elder, DO
Title
Ceo
Phone
(316) 866-2066

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3701 E 13TH St N
Wichita, KS 67208-2086

Mailing address

1150 N Broadway Ave
Wichita, KS 67214-2805
Phone (316) 866-2000

Other names 1

  • GraceMed Good Samaritan Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101115000395 KS Part A Provider - Federally Qualified Health Center (FQHC) 9830098185 1 other NPI on this enrollment
Practice locations: Wichita, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659631695. Details of each certification follow.

Federally qualified health center certification: CCN 171837

Legal name
GRACEMED HEALTH CLINIC INC
Doing business as
GRACEMED GOOD SAMARITAN CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 14, 2010
Last certification
Dec 14, 2010
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jun 21, 1994 in KS
Enrollment address
3701 E 13TH St N
Wichita, KS 67208-2086

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Gracemed Health Clinic Inc17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Venus Lee Individual Corporate Officer Jan 23, 2022
W-2 Managing EmployeeCoo/Aeo May 15, 2015
Gracemed Health Clinic Inc Organization, Wichita, KS Non-profit Operational/Managerial Control Jan 1, 2006 100%

Owners & managing parties with NPI records 13

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

View all 13

All facility ownership & control disclosures 9

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

FacilityTypeRoleSince
Gracemed Mother Mary Anne ClinicWichita, KS, CCN 171841 Federally qualified health center Operational/Managerial Control (100%) Feb 23, 2012
Gracemed Dodge Family ClinicWichita, KS, CCN 171847 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2013
Gracemed Oaklawn Family ClinicWichita, KS, CCN 171852 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 28, 2018
Jul 28, 2014
Gracemed Jardine Family ClinicWichita, KS, CCN 171855 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2015
Gracemed Meyer Family ClinicWichita, KS, CCN 171857 Federally qualified health center Operational/Managerial Control (100%) Oct 15, 2015
Gracemed Highland Park Family ClinicTopeka, KS, CCN 171866 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2016
Gracemed Capitol Family ClinicTopeka, KS, CCN 171864 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2016
Gracemed Virginia & George Ablah Family ClinicWichita, KS, CCN 171865 Federally qualified health center Operational/Managerial Control (100%) Mar 15, 2016
Gracemed Clearwater Family ClinicClearwater, KS, CCN 171883 Federally qualified health center Operational/Managerial Control (100%) Nov 19, 2018

Owned or controlled facilities with NPI records 10

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

Facilities with the same owner 9

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

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1337817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757289600000",
    "number": "1659631695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 N BROADWAY AVE",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672142805",
            "telephone_number": "316-866-2000",
            "fax_number": "316-866-2084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 E 13TH ST N",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672082086",
            "telephone_number": "316-866-2000",
            "fax_number": "316-866-2084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACEMED HEALTH CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-24",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A",
        "authorized_official_last_name": "ELDER",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "316-866-2066",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GraceMed Good Samaritan Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GraceMed Good Samaritan Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.