NPIMap

Organization Active NPI

Ukhs Great Bend, LLC

Doing business as The University of Kansas Health System Great Bend Campus

  • General Acute Care Hospital
  • Great Bend, KS
National Provider Identifier
1669962593
Registry record updated Mar 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
UKHS GREAT BEND, LLC
Doing business as
The University of Kansas Health System Great Bend Campus
Practice address
514 Cleveland St
Great Bend, KS 67530
Phone
(620) 792-8833
NPI assigned
May 16, 2018
Last updated
Mar 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2020

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

Authorized official

Name
Jesse Mock
Title
Authorized Official
Phone
(620) 791-6272

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

514 Cleveland St
Great Bend, KS 67530

Mailing address

514 Cleveland St
Great Bend, KS 67530-3562
Phone (620) 792-8833

Other names 1

  • The University of Kansas Health System Great Bend Campus Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181002001027 KS Part A Provider - Hospital 5597016378 Practice locations: Great Bend, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669962593. Details of each certification follow.

Hospital certification: CCN 17U191

Legal name
UKHS GREAT BEND LLC
Doing business as
THE UNIVERSITY OF KANSAS HEALTH SYSTEM GREAT BEND CAMPUS
Organization structure
LLCProprietary
Incorporated
May 8, 2018 in KS
Enrollment address
514 Cleveland St
Great Bend, KS 67530-3562
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Ukhs Great Bend LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Timothy a Latimer Individual Corporate DirectorDirector of Finance/Controller Aug 1, 2018 5%
Operational/Managerial ControlDirector of Finance/Controller Aug 1, 2018 5%
Catherine R Wiens Individual Corporate Officer Sep 1, 2023
John Worden Individual Corporate Officer Sep 1, 2023
Operational/Managerial Control Sep 1, 2023
Daniel Peters Individual Corporate Officer Sep 1, 2023
University of Kansas Hospital Authority Organization, Kansas City, KS Corporation, Non-profit 5% Or Greater Direct Ownership Interest Aug 1, 2018 99.9%

Owners & managing parties with NPI records 11

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

Facilities with the same owner 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1526428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583884800000",
    "number": "1669962593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 CLEVELAND ST",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675303562",
            "telephone_number": "620-792-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 CLEVELAND ST",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "67530",
            "telephone_number": "620-792-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UKHS GREAT BEND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-16",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A",
        "authorized_official_last_name": "MOCK",
        "authorized_official_first_name": "JESSE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "620-791-6272"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The University of Kansas Health System Great Bend Campus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Great Bend, KS

Sources for this page

Verify at the official NPI Registry.