Minneola District Hospital NBR 2
Organization Active NPI Rural Health Clinic/Center · Fowler, KS
NPI 1700975729 · NPPES record last updated Aug 22, 2022
Key facts
- NPI
- 1700975729
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- H013002 (KS)
- Legal business name
- MINNEOLA DISTRICT HOSPITAL NBR 2
- Practice address
- 404 Main Street
Fowler, KS 67844-0462 - Phone
- (620) 646-5446
- Fax
- (620) 646-5708
- NPI assigned
- Oct 11, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- MINNEOLA DISTRICT HOSPITAL NBR 2
Authorized official
- Name
- Deborah Bruner
- Title
- Ceo
- Phone
- (620) 885-4264
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 4
Practitioners 40
-
Matthew C Ridder, ARNP
-
Mirza Ahmad, MD
-
Lauren A Amy, PAC
-
Trent Dylan Befort, APRN
-
Jonathan A Borchard, PAC
-
Peter Arthur Burgos, M.D.
-
Halie Davis, PA-C
-
David P. Demint Jr., CRNA
-
Rebecca Erb, PA
-
Kelly Bruce Gabel, D.O.
-
Jennifer Ann Imel, APRN
-
Kent R Wagner, PA
-
Ryan Lee Weir, MD
-
Chance Williams, M.D.
-
Douglas L Best, MD
-
Tamara Carroll, M.D.
-
Elsie Haynes, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D0964323 | Fowler Community Clinic | Provider-performed microscopy | Aug 22, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KS
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
- Other · Non-profit
- Enrollment address
- 404 N Main St
Fowler, KS 67844-9998 - Related CCNs
- 178536
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Winfield Denton |
Corporate Director |
Jan 8, 2018 | |
| Dianna Beebe |
Corporate Director |
May 1, 2015 | |
| Deborah a Bruner |
Corporate Director |
Oct 23, 2012 | |
| W-2 Managing Employee |
Oct 23, 2012 | ||
| William Baker |
Corporate Director |
Jan 8, 2018 | |
| Gail Norton |
Corporate Director |
May 1, 2015 | |
| Jennifer Denison |
Corporate Director |
May 1, 2015 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Minneola District Hospital |
Hospital | Other (100%) | Jun 24, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- Minneola Dist Hosp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | H013002 | KS | Yes |
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
- Fowler Community Clinic
Other providers in Fowler, KS
- Fowler Hospital District
- Meade Hospital District
- Shawna Dea Miller
- Restore Home Health Agency LLC
- Usd225, Fowler
All providers in Fowler, KS · Rural Health Clinic/Center in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.