NPIMap

Organization Active NPI

Hiawatha Hospital Association Inc

Doing business as Amberwell Highland Clinic

  • Rural Health Clinic/Center
  • Highland, KS
National Provider Identifier
1700936440
Registry record updated Nov 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HIAWATHA HOSPITAL ASSOCIATION INC
Doing business as
Amberwell Highland Clinic
Practice address
415 W Main St
Highland, KS 66035-4143
Phone
(785) 442-3213
Fax
(785) 442-5572
NPI assigned
Jan 12, 2007
Last updated
Nov 15, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
HIAWATHA HOSPITAL ASSOCIATION INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 15, 2024

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

Authorized official

Name
Mr. Jared Abel
Title
Ceo
Phone
(785) 742-2131

Specialties & licenses 1

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

Addresses

Primary practice location

415 W Main St
Highland, KS 66035-4143

Mailing address

300 Utah St
Hiawatha, KS 66434-2326
Phone (785) 742-2131

Other identifiers 2

IdentifierTypeStateIssuer
110492OtherKSBCBS
100009740AMedicaidKS

Other names 1

  • Amberwell Highland Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040309000220 KS Part B Supplier - Clinic/Group Practice 9032007364 Receives reassigned benefits from 80 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hiawatha, KS; Highland, KS
O20041220001135 KS Part A Provider - Rural Health Clinic 9032007364 Practice locations: Highland, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700936440. Details of each certification follow.

Rural health clinic certification: CCN 173491

Legal name
HIAWATHA HOSPITAL ASSOCIATION INC
Doing business as
AMBERWELL HIGHLAND CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 1, 1999
Last certification
Aug 21, 2018
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
415 W Main St
Highland, KS 66035-4143

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 4

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
17D0699093Amberwell Highland Clinic415 W Main Street, Highland, KS 66035Certificate of waiverOct 24, 2027

National Provider Directory

National Provider Directory
Part of
ER Group

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
John a Moore Individual Corporate OfficerBoard Secretary/Treasurer Jan 26, 2021
Corporate DirectorBoard Member Jan 26, 2021
Chase Dudzinski Individual Corporate OfficerCfo Aug 1, 2022
Corporate DirectorCfo Aug 1, 2022
W-2 Managing Employee Aug 1, 2022
Jason Smith Individual Corporate OfficerBoard Vice- Chairperson Jan 1, 2024
Corporate DirectorBoard Member Apr 25, 2023
Alison Kerl Individual Corporate OfficerCoo Mar 26, 2021
Corporate DirectorCoo Mar 26, 2021
W-2 Managing Employee Mar 26, 2021
William G Geisendorf Individual Corporate DirectorBoard Member Jan 1, 2018
Kelli R McCarty Individual W-2 Managing EmployeeExecutive Director of Revenue Cycle Mar 31, 2014
Peter Rosa Individual Corporate DirectorCos Jan 1, 2026
W-2 Managing EmployeeMD;Cos Jan 1, 2025
Benjamin Walker Individual Corporate DirectorBoard Member Oct 1, 2025
Del Elffner Individual Corporate OfficerBoard Vice President Jan 2, 2019
Corporate DirectorBoard Member Jan 2, 2019
Nichole Chamley Individual Corporate OfficerCno Jul 26, 2021
Corporate DirectorCno Jul 26, 2021
W-2 Managing Employee Jul 26, 2021
Howard E Elliott Individual Corporate DirectorBoard Member Jun 22, 2021
Jennifer Brockhoff Individual W-2 Managing EmployeeExe. Director of Clinic Operations Oct 1, 2022
Jared Abel Individual Corporate OfficerCeo Jun 15, 2024
Corporate DirectorCeo Jun 15, 2024
W-2 Managing Employee Jun 15, 2024
Chad Gormley Individual Corporate DirectorBoard Member Jan 1, 2026

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731628800000",
    "number": "1700936440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 UTAH ST",
            "city": "HIAWATHA",
            "state": "KS",
            "postal_code": "664342326",
            "telephone_number": "785-742-2131",
            "fax_number": "785-742-6554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 W MAIN ST",
            "city": "HIGHLAND",
            "state": "KS",
            "postal_code": "660354143",
            "telephone_number": "785-442-3213",
            "fax_number": "785-442-5572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIAWATHA HOSPITAL ASSOCIATION INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HIAWATHA HOSPITAL ASSOCIATION INC",
        "enumeration_date": "2007-01-12",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A",
        "authorized_official_last_name": "ABEL",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "785-742-2131",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "110492",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100009740A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Amberwell Highland Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Highland, KS

Sources for this page

Verify at the official NPI Registry.