NPIMap

Organization Active NPI

Neosho Memorial Regional Medical Center

Doing business as NMRMC Erie Family Care Clinic

  • Rural Health Clinic/Center
  • Erie, KS
National Provider Identifier
1679902126
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H-067-001 Issued in KS
Legal business name
NEOSHO MEMORIAL REGIONAL MEDICAL CENTER
Doing business as
NMRMC Erie Family Care Clinic
Practice address
13920 Highway 59
Erie, KS 66733-5001
Phone
(620) 244-5105
Fax
(620) 244-5111
NPI assigned
Nov 5, 2013
Last updated
Oct 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Authorized official

Name
Lauren K Tinsley
Title
Cfo
Phone
(620) 431-4000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X H-067-001 KS Primary

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 1

IdentifierTypeStateIssuer
30003941860020MedicaidKS

Other names 1

  • NMRMC Erie Family Care Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address stacipage@Neosho.CernerDirect.com Direct

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679902126. Details of each certification follow.

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
GovernmentNon-profit
Enrollment address
13920 Highway 59
Erie, KS 66733-5001
Related CCNs
171380

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 8

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
17D2071794Nmrmc Erie Family Care Clinic13920 Highway 59, Erie, KS 66733Certificate of waiverJan 16, 2028

National Provider Directory

National Provider Directory
Tax ID family
Neosho Memorial Hospita15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Philip a Jarred Individual Operational/Managerial ControlTreasurer May 1, 2017
Wendy Brazil Individual Corporate OfficerCoo Jan 1, 2021
Operational/Managerial ControlCoo Jan 1, 2021
Bruce a Mullen Individual Operational/Managerial ControlVice-Chairman Apr 1, 1996
Bruce Jackson Individual Operational/Managerial ControlChairman Aug 16, 2006
Katie Tinsley Individual Corporate OfficerCfo Jan 1, 2021
Operational/Managerial ControlCfo Jan 1, 2021
Dennis Franks Individual Contracted Managing EmployeeCeo Apr 1, 2006 100%
David M Robinson Individual Operational/Managerial Control Apr 1, 2003
Alison Mih Individual Operational/Managerial ControlBoard Member Mar 30, 2021
Neosho Memorial Regional Medical Center Organization, Chanute, KS 5% Or Greater Direct Ownership Interest Nov 1, 2013 100%
Garrett Sharp Individual Operational/Managerial ControlBoard Member Mar 30, 2021
Larry Nelson Individual Operational/Managerial ControlBoard Member Nov 2, 2012

Owners & managing parties with NPI records 6

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1383609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730073600000",
    "number": "1679902126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 426",
            "city": "CHANUTE",
            "state": "KS",
            "postal_code": "667200426",
            "telephone_number": "620-431-4000",
            "fax_number": "620-431-7556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13920 HIGHWAY 59",
            "city": "ERIE",
            "state": "KS",
            "postal_code": "667335001",
            "telephone_number": "620-244-5105",
            "fax_number": "620-244-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEOSHO MEMORIAL REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-05",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A",
        "authorized_official_last_name": "TINSLEY",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "620-431-4000"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KS",
            "license": "H-067-001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30003941860020",
            "state": "KS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stacipage@Neosho.CernerDirect.com",
            "affiliation": "N",
            "endpointDescription": "NMRMC Erie Family Med Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "13920 Highway 59",
            "city": "Erie",
            "state": "KS",
            "country_code": "US",
            "postal_code": "667335001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "NMRMC Erie Family Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NMRMC Erie Family Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Erie, KS

Sources for this page

Verify at the official NPI Registry.