NPIMap

Community Healthcare System, Inc

Organization Active NPI Rural Health Clinic/Center · Centralia, KS

NPI 1699747279 · NPPES record last updated Jun 2, 2020

Key facts

NPI
1699747279
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
H075001 (KS)
Legal business name
COMMUNITY HEALTHCARE SYSTEM, INC
Practice address
606 1St St
Centralia, KS 66415-9637
Phone
(785) 857-3334
Fax
(785) 857-3349
NPI assigned
Feb 7, 2006
Organization subpart
No

Authorized official

Name
Mr. Todd M Willert
Title
Ceo
Phone
(785) 889-5002

Other NPIs with the same Medicare PAC ID 10

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

Corporate family (same tax ID) 16

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

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 31

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D0668702Centralia Medical Clinic
606 First Street, Centralia, KS 66415		Certificate of waiverAug 1, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled in KS

Rural health clinic certification: CCN 173483

Legal name
COMMUNITY HEALTHCARE SYSTEM INC
Doing business as
CENTRALIA MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 1998
Last certification
Mar 6, 2018
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
May 14, 1986 in KS
Enrollment address
606 1St St
Centralia, KS 66415-9637

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Justin Boswell
Individual 		Corporate Director Mar 31, 2006
Todd M Willert
Individual 		Corporate Officer
Ceo		 Mar 24, 2015
W-2 Managing Employee
Ceo		 Mar 24, 2015
Lorraine Meyer
Individual 		Corporate Officer
Coo		 May 17, 2017
W-2 Managing Employee
Coo		 May 17, 2017

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040601000073 KS Part a Provider - Rural Health Clinic 8325031529 Practice locations: Centralia, KS

National Provider Directory

Tax ID family
Community Hospital Ambula (17 organizations share this tax ID)

Locations

606 1st St
Centralia, KS 66415
Phone (785) 857-3334

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X H075001 KS Yes

Addresses

Primary practice location

606 1St St
Centralia, KS 66415-9637

Mailing address

606 1St St
Centralia, KS 66415-9637
Phone (785) 857-3334

Other identifiers

IdentifierTypeStateIssuer
001436OtherKSBLUE CROSS BLUE SHIELD
100319940AMedicaidKS

Other names

  • Centralia Medical Clinic Doing business as

Other providers in Centralia, KS

All providers in Centralia, KS · Rural Health Clinic/Center in Kansas

Sources for this page

Verify at the official NPI Registry.