NPIMap

Organization Active NPI

Minneola District Hospital NBR 2

Doing business as Fowler Community Clinic

  • Rural Health Clinic/Center
  • Fowler, KS
National Provider Identifier
1700975729
Registry record updated Aug 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H013002 Issued in KS
Legal business name
MINNEOLA DISTRICT HOSPITAL NBR 2
Doing business as
Fowler Community Clinic
Practice address
404 Main Street
Fowler, KS 67844-0462
Phone
(620) 646-5446
Fax
(620) 646-5708
NPI assigned
Oct 11, 2006
Last updated
Aug 22, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
MINNEOLA DISTRICT HOSPITAL NBR 2As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 22, 2022

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

Authorized official

Name
Deborah Bruner
Title
Ceo
Phone
(620) 885-4264

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X H013002 KS Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

404 Main Street
Fowler, KS 67844-0462

Mailing address

PO Box 462
Fowler, KS 67844-0462
Phone (620) 646-5446

Other names 1

  • Fowler Community 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
O20050302000745 KS Part B Supplier - Clinic/Group Practice 1355252545 Receives reassigned benefits from 61 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dodge City, KS; Minneola, KS; Fowler, KS
O20051221000924 KS Part A Provider - Rural Health Clinic 1355252545 Practice locations: Fowler, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700975729. Details of each certification follow.

Rural health clinic certification: CCN 178536

Legal name
MINNEOLA DISTRICT HOSPITAL NBR 2
Doing business as
FOWLER COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 30, 2006
Last certification
Nov 10, 2011
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
404 N Main St
Fowler, KS 67844-9998
Related CCNs
178536

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 3

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
17D0964323Fowler Community Clinic404 Main, Fowler, KS 67844Provider-performed microscopyAug 22, 2027

National Provider Directory

National Provider Directory
Part of
Minneola Dist Hosp

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Winfield Denton Individual Corporate DirectorBoard Member Jan 8, 2018
Dianna Beebe Individual Corporate DirectorBoard President May 1, 2015
Deborah a Bruner Individual Corporate DirectorCeo Oct 23, 2012
W-2 Managing EmployeeCeo Oct 23, 2012
William Baker Individual Corporate DirectorBoard Member Jan 8, 2018
Gail Norton Individual Corporate DirectorBoard Member May 1, 2015
Jennifer Denison Individual Corporate DirectorBoard Member May 1, 2015

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Minneola District HospitalMinneola, KS, CCN 171368 Hospital Other (100%) Jun 24, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 12

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": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661126400000",
    "number": "1700975729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 462",
            "city": "FOWLER",
            "state": "KS",
            "postal_code": "678440462",
            "telephone_number": "620-646-5446",
            "fax_number": "620-646-5708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 MAIN STREET",
            "city": "FOWLER",
            "state": "KS",
            "postal_code": "678440462",
            "telephone_number": "620-646-5446",
            "fax_number": "620-646-5708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNEOLA DISTRICT HOSPITAL NBR 2",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MINNEOLA DISTRICT HOSPITAL NBR 2",
        "enumeration_date": "2006-10-11",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A",
        "authorized_official_last_name": "BRUNER",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "620-885-4264"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KS",
            "license": "H013002",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fowler Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fowler Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fowler, KS

Sources for this page

Verify at the official NPI Registry.