NPIMap

Organization Active NPI

Commonspirit Kansas, Inc.

  • Rural Health Clinic/Center
  • Ulysses, KS
National Provider Identifier
1710422795
Registry record updated Jun 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COMMONSPIRIT KANSAS, INC.
Practice address
505 N Main St
Ulysses, KS 67880-2135
Phone
(620) 356-1266
Fax
(620) 356-3846
NPI assigned
Dec 29, 2016
Reactivated
Jun 25, 2025
Organization subpart
Yes
Parent organization
COMMONSPIRIT HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 25, 2025

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

Authorized official

Name
Mr. Tadd Richert
Title
Region Chief Financial Officer
Phone
(303) 673-7864

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

505 N Main St
Ulysses, KS 67880-2135

Mailing address

PO Box 803929
Kansas City, MO 64180-3929
Phone (800) 953-0104

Other identifiers 3

IdentifierTypeStateIssuer
9000166710MedicaidCO
100030210LMedicaidKS
100694540DMedicaidOK

Other names 4

  • Bob Wilson Memorial Hospital Doing business as
  • PRUL PC ULYSSES Doing business as
  • St. Catherine Hospital Former legal business name
  • CMG Primary Care Ulysses Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170118000623 KS Part A Provider - Rural Health Clinic 4789595844 Practice locations: Ulysses, KS

Rural health clinic certification: CCN 173465

Legal name
COMMONSPIRIT KANSAS INC
Doing business as
BOB WILSON MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 10, 1997
Last certification
Feb 19, 2013
Ownership / control type
2B
Most recent change of ownership
Feb 1, 2016 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
505 N Main St
Ulysses, KS 67880-2135
Related CCNs
170110

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
St Catherine Home HLTH27 organizations share this tax ID, including this one
Part of
Catholic Health Initiatives

Other organizations with this tax ID 26

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

View all 26

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Shawna Rene Roark Individual Corporate OfficerVP Finance & Cfo Jan 2, 2021
Operational/Managerial ControlVP Finance & Cfo Jul 1, 2022
Commonspirit Health Organization, Chicago, IL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2018 100%
Fred Dierksen Individual Corporate DirectorAdvisory Board Member Apr 1, 2025
Twilla Lee Individual Corporate DirectorAdvisory Board Member Apr 1, 2025
Commonspirit Mountain Region Organization, Centennial, CO Corporation, Management services company, Non-profit Operational/Managerial Control Jan 1, 2018 100%
Darrin Figgins Individual Corporate DirectorAdvisory Board Member Apr 1, 2025
Bryan Kent Stucky Individual Corporate DirectorAdvisory Board Member Apr 1, 2025
Vivian Fankhauser Individual Corporate DirectorAdvisory Board Member Apr 1, 2025
Jeremy J Presley Individual Corporate DirectorAdvisory Board Member Apr 1, 2025
P-Jay Patel Individual Corporate DirectorAdvisory Board Member Apr 1, 2025
Mitch Melfi Individual Corporate DirectorBoard Member Apr 1, 2025
Tadd Richert Individual Corporate OfficerRegion Chief Financial Officer Jul 3, 2022
Operational/Managerial ControlRegion Chief Financial Officer May 1, 2022
Janice Thome Individual Corporate DirectorAdvisory Board Member Apr 1, 2025
Sheri Shapiro Individual Corporate DirectorBoard Member Apr 1, 2025
Katherine Brooks Individual Corporate OfficerSecretary Apr 1, 2025
Andrew Gaasch Individual Corporate OfficerTreasurer Mar 7, 2021
Operational/Managerial ControlPresident Mountain Region May 1, 2022
Merrill Ray Conant Individual Corporate DirectorAdvisory Board Member Apr 1, 2025

Owners & managing parties with NPI records 3

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

Facilities with the same owner 35

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 35

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1482969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750809600000",
    "number": "1710422795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 803929",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641803929",
            "telephone_number": "800-953-0104",
            "fax_number": "303-765-6670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 N MAIN ST",
            "city": "ULYSSES",
            "state": "KS",
            "postal_code": "678802135",
            "telephone_number": "620-356-1266",
            "fax_number": "620-356-3846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONSPIRIT KANSAS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMONSPIRIT HEALTH",
        "enumeration_date": "2016-12-29",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "deactivation_date": "2025-06-02",
        "reactivation_date": "2025-06-25",
        "status": "A",
        "authorized_official_last_name": "RICHERT",
        "authorized_official_first_name": "TADD",
        "authorized_official_title_or_position": "REGION CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "303-673-7864",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000166710",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100030210L",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100694540D",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bob Wilson Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PRUL PC ULYSSES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PRUL PC ULYSSES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Catherine Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "CMG Primary Care Ulysses",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ulysses, KS

Sources for this page

Verify at the official NPI Registry.