NPIMap

Organization Active NPI

Great Bend Regional Hospital, LLC

  • General Acute Care Hospital
  • Great Bend, KS
National Provider Identifier
1720041684
Registry record updated Aug 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
H005004 Issued in KS
Legal business name
GREAT BEND REGIONAL HOSPITAL, LLC
Practice address
514 Cleveland Street
Great Bend, KS 67530-3562
Phone
(620) 792-8833
Fax
(620) 792-1448
NPI assigned
Apr 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2011

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

Authorized official

Name
Larry T Fore
Title
Controller
Phone
(620) 791-6815

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X H005004 KS Primary

Addresses

Primary practice location

514 Cleveland Street
Great Bend, KS 67530-3562

Mailing address

514 Cleveland Street
Great Bend, KS 67530-3562
Phone (620) 792-8833

Other identifiers 2

IdentifierTypeStateIssuer
001506OtherKSBCBS
0187321801MedicaidKS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory

Locations

711 Marsh Ave
Kinsley, KS 67547
Phone (316) 659-3639

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Sheila P Fleske Individual 5% Or Greater Direct Ownership Interest Jan 28, 2009 10.13%
Leonard Thomas Fleske Individual Corporate Director Jan 28, 2009
Brent Hanson Individual W-2 Managing EmployeeCeo Jul 16, 2014
Operational/Managerial Control Jul 16, 2014
David T Gillenwater Individual 5% Or Greater Direct Ownership Interest Jan 28, 2009 8.68%
Laina C Marshall Individual 5% Or Greater Direct Ownership Interest Jan 28, 2009 10.13%
Roger W Marshall Individual Corporate Director Jan 28, 2009
Donald E Beahm Individual 5% Or Greater Direct Ownership InterestMD Jan 1, 2011 10.13%
Hildebrand Investments LP Organization, Great Bend, KS 5% Or Greater Direct Ownership Interest Dec 17, 2013 10.13%
Jeffrey Brozek Individual 5% Or Greater Direct Ownership Interest Jan 28, 2009 10.13%
Nuehealth Equity Co. LLC Organization, Leawood, KS 5% Or Greater Direct Ownership Interest May 1, 2009
Perry M Smith Revocable Trust Organization, Great Bend, KS 5% Or Greater Direct Ownership Interest May 1, 2009 10.13%

Practitioners & affiliated clinicians

Practitioners 1

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": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312934400000",
    "number": "1720041684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 CLEVELAND STREET",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675303562",
            "telephone_number": "620-792-8833",
            "fax_number": "620-792-1448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 CLEVELAND STREET",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675303562",
            "telephone_number": "620-792-8833",
            "fax_number": "620-792-1448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT BEND REGIONAL HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2011-08-10",
        "status": "A",
        "authorized_official_last_name": "FORE",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "620-791-6815"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "KS",
            "license": "H005004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "001506",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0187321801",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Bend, KS

Sources for this page

Verify at the official NPI Registry.