NPIMap

Organization Active NPI

Community Healthcare System, Inc

Doing business as Centralia Medical Clinic

  • Rural Health Clinic/Center
  • Centralia, KS
National Provider Identifier
1699747279
Registry record updated Jun 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H075001 Issued in KS
Legal business name
COMMUNITY HEALTHCARE SYSTEM, INC
Doing business as
Centralia Medical Clinic
Practice address
606 1St St
Centralia, KS 66415-9637
Phone
(785) 857-3334
Fax
(785) 857-3349
NPI assigned
Feb 7, 2006
Last updated
Jun 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2020

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

Authorized official

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

Specialties & licenses 1

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

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 names 1

  • Centralia Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699747279. Details of each certification follow.

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
CorporationNon-profit
Incorporated
May 14, 1986 in KS
Enrollment address
606 1St St
Centralia, KS 66415-9637

Other NPIs with the same Medicare PAC ID 10

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

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
17D0668702Centralia Medical Clinic606 First Street, Centralia, KS 66415Certificate of waiverAug 1, 2026

National Provider Directory

National Provider Directory
Tax ID family
Rural Health Clinic17 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 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 OfficerCeo Mar 24, 2015
W-2 Managing EmployeeCeo Mar 24, 2015
Lorraine Meyer Individual Corporate OfficerCoo May 17, 2017
W-2 Managing EmployeeCoo May 17, 2017

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": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591056000000",
    "number": "1699747279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 1ST ST",
            "city": "CENTRALIA",
            "state": "KS",
            "postal_code": "664159637",
            "telephone_number": "785-857-3334",
            "fax_number": "785-857-3349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 1ST ST",
            "city": "CENTRALIA",
            "state": "KS",
            "postal_code": "664159637",
            "telephone_number": "785-857-3334",
            "fax_number": "785-857-3349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTHCARE SYSTEM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2020-06-02",
        "certification_date": "2020-06-02",
        "status": "A",
        "authorized_official_last_name": "WILLERT",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "785-889-5002",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KS",
            "license": "H075001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centralia Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Centralia Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centralia, KS

Sources for this page

Verify at the official NPI Registry.