Neosho Memorial Regional Medical Center
Organization Active NPI Rural Health Clinic/Center · Erie, KS
NPI 1679902126 · NPPES record last updated Oct 28, 2024
Key facts
- NPI
- 1679902126
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- H-067-001 (KS)
- Legal business name
- NEOSHO MEMORIAL REGIONAL MEDICAL CENTER
- Practice address
- 13920 Highway 59
Erie, KS 66733-5001 - Phone
- (620) 244-5105
- Fax
- (620) 244-5111
- NPI assigned
- Nov 5, 2013
- Organization subpart
- No
Authorized official
- Name
- Lauren K Tinsley
- Title
- Cfo
- Phone
- (620) 431-4000
Owners & managing parties with NPI records 6
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 14
Related certifications (CCN) 3
Practitioners 26
-
Elizabeth B. Nothern, PA-C
-
Garrett Barton, M.D.
-
Kinzie Barton, MD
-
Erika Dawn Dick, APRN
-
David M Guernsey, MD
-
Amy L Hunt, PA-C
-
Yi Ying Law, MD
-
Bruce W Lee, D.O.
-
Matthew Leroy, MD
-
Candice Lynn Morris, APRN
-
Gennie Marie Mullen, APRN-C
-
Brett D Olson, PA
-
Suzanne Peters, NP
-
Christopher T Rehler, APRN
-
John Jason Robinson, M.D.
-
Mallori Smith, PA-C
-
Cathy M. Taylor, M.D.
-
Robert K Thomen II, M.D.
-
Randall Edward Tindle, NP FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D2071794 | Nmrmc Erie Family Care Clinic | Certificate of waiver | Jan 16, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KS
Rural health clinic certification: CCN 178584
- Legal name
- NEOSHO MEMORIAL REGIONAL MEDICAL CENTER
- Doing business as
- NMRMC ERIE FAMILY CARE CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jun 17, 2014
- Last certification
- Jun 17, 2014
- Ownership / control type
- 2B
- Organization structure
- Government · Non-profit
- Enrollment address
- 13920 Highway 59
Erie, KS 66733-5001 - Related CCNs
- 171380
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Philip a Jarred |
Operational/Managerial Control |
May 1, 2017 | |
| Wendy Brazil |
Corporate Officer |
Jan 1, 2021 | |
| Operational/Managerial Control |
Jan 1, 2021 | ||
| Bruce a Mullen |
Operational/Managerial Control |
Apr 1, 1996 | |
| Bruce Jackson |
Operational/Managerial Control |
Aug 16, 2006 | |
| Katie Tinsley |
Corporate Officer |
Jan 1, 2021 | |
| Operational/Managerial Control |
Jan 1, 2021 | ||
| Dennis Franks |
Contracted Managing Employee |
Apr 1, 2006 | 100% |
| David M Robinson |
Operational/Managerial Control | Apr 1, 2003 | |
| Alison Mih |
Operational/Managerial Control |
Mar 30, 2021 | |
| Neosho Memorial Regional Medical Center |
5% Or Greater Direct Ownership Interest | Nov 1, 2013 | 100% |
| Garrett Sharp |
Operational/Managerial Control |
Mar 30, 2021 | |
| Larry Nelson |
Operational/Managerial Control |
Nov 2, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040129000863 | KS | Part B Supplier - Clinic/Group Practice | 9133022882 |
Receives reassigned benefits from 50 practitioners 8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Chanute, KS; Erie, KS |
| O20131218000288 | KS | Part a Provider - Rural Health Clinic | 9133022882 | Practice locations: Erie, KS |
National Provider Directory
- Tax ID family
- Neosho Memorial Hospita
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | |||
| Rural Health Clinic/Center | 261QR1300X | H-067-001 | KS | Yes |
Addresses
Primary practice location
13920 Highway 59
Erie, KS 66733-5001
Mailing address
PO Box 426
Chanute, KS 66720-0426
Phone (620) 431-4000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30003941860020 | Medicaid | KS |
Other names
- NMRMC Erie Family Care Clinic
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | stacipage@Neosho.CernerDirect.com | Direct |
Other providers in Erie, KS
- Morgan June Isbell
- Dana Kepley
- Labette County Medical Center
- Lightning Creek Investment Group, Inc
- Linda May Lollar
- Suzanne Peters
- Richeys Drug Store Inc
- Richeys Rexall Drug Inc
- Seventh St Pharmacy Inc
- Barbara A Smith
All providers in Erie, 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 Oct 28, 2024. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.