NPIMap

Organization Active NPI

Jefferson County Memorial Hospital, Inc

Doing business as Jefferson Medical Clinic

  • Physician Assistant
  • Winchester, KS
National Provider Identifier
1750354908
Registry record updated Sep 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
JEFFERSON COUNTY MEMORIAL HOSPITAL, INC
Doing business as
Jefferson Medical Clinic
Practice address
408 Delaware St
Winchester, KS 66097-4003
Phone
(913) 774-4340
Fax
(913) 774-3379
NPI assigned
Feb 8, 2006
Last updated
Sep 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2021

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

Authorized official

Name
Lamont Cook
Title
Ceo
Phone
(913) 774-4340

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X Primary

Addresses

Primary practice location

408 Delaware St
Winchester, KS 66097-4003

Mailing address

408 Delaware St
Winchester, KS 66097-4003
Phone (913) 774-4340

Other names 1

  • Jefferson Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050215000085 KS Part B Supplier - Clinic/Group Practice 6002868445 Receives reassigned benefits from 10 practitioners
4 other NPIs on this enrollment
Practice locations: Winchester, KS; Basehor, KS

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

15630 Pinehurst Dr
Ste 5
Basehor, KS 66007
Phone (913) 662-7042

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631145600000",
    "number": "1750354908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 DELAWARE ST",
            "city": "WINCHESTER",
            "state": "KS",
            "postal_code": "660974003",
            "telephone_number": "913-774-4340",
            "fax_number": "913-774-3379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 DELAWARE ST",
            "city": "WINCHESTER",
            "state": "KS",
            "postal_code": "660974003",
            "telephone_number": "913-774-4340",
            "fax_number": "913-774-3379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COUNTY MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-08",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "LAMONT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "913-774-4340"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jefferson Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winchester, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.