NPIMap

Organization Active NPI

Susan B. Allen Memorial Hospital

  • General Acute Care Hospital
  • El Dorado, KS
National Provider Identifier
1700994977
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
SUSAN B. ALLEN MEMORIAL HOSPITAL
Doing business as
Susan B. Allen Memorial Hospital
Practice address
720 W. Central Ave
El Dorado, KS 67042-2144
Phone
(316) 321-3300
Fax
(316) 321-2916
NPI assigned
Aug 28, 2006
Last updated
May 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2024

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

Authorized official

Name
Melissa Hall
Title
Ceo
Phone
(316) 322-4558

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary
Pharmacy 333600000X 2-08568 KS
Community/Retail Pharmacy 3336C0003X
Institutional Pharmacy 3336I0012X

Addresses

Primary practice location

720 W. Central Ave
El Dorado, KS 67042-2144

Mailing address

720 W. Central Ave
El Dorado, KS 67042-2144
Phone (316) 321-3300

Other identifiers 1

IdentifierTypeStateIssuer
2160905OtherPK

Other names 1

  • Susan B. Allen Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030912000022 KS Part A Provider - Hospital 7719898980 4 other NPIs on this enrollment
Practice locations: El Dorado, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700994977. Details of each certification follow.

Hospital certification: CCN 170017

Legal name
SUSAN B ALLEN MEMORIAL HOSPITAL
Doing business as
SUSAN B ALLEN MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 5, 2004
Beds
80
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jul 14, 1930 in KS
Enrollment address
720 W Central Ave
El Dorado, KS 67042-2112
Other Hospital Practice Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Susan B Allen Memorial HospitalCCN 170017 · All quality measures
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Susan B Allen Hospital8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

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
Erin Burden Individual Corporate Director Feb 8, 2024
W-2 Managing Employee Feb 8, 2024
Leonard Hernandez Individual Corporate OfficerCeo Sep 30, 2020 5%
W-2 Managing EmployeeCeo Sep 30, 2020 5%
Operational/Managerial ControlCeo Sep 30, 2020 5%
Michael Massey Individual Corporate Director Feb 8, 2024
W-2 Managing EmployeeCfo Feb 8, 2024
Operational/Managerial Control Feb 8, 2024

Practitioners & affiliated clinicians

Practitioners 14

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 14

Affiliated clinicians 157

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 157

NPI Registry JSON

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715817600000",
    "number": "1700994977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 W. CENTRAL AVE",
            "city": "EL DORADO",
            "state": "KS",
            "postal_code": "670422144",
            "telephone_number": "316-321-3300",
            "fax_number": "316-321-2916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 W. CENTRAL AVE",
            "city": "EL DORADO",
            "state": "KS",
            "postal_code": "670422144",
            "telephone_number": "316-321-3300",
            "fax_number": "316-321-2916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN B. ALLEN MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-28",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "316-322-4558"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "KS",
            "license": "2-08568",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2160905",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susan B. Allen Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Susan B. Allen Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Dorado, KS

Sources for this page

Verify at the official NPI Registry.