Western Roots Medical Clinic LLC

Key facts

NPI: 1770345910
Entity type: Organization (NPI type 2)
Primary specialty: Family Medicine Physician 207Q00000X
Legal business name: WESTERN ROOTS MEDICAL CLINIC LLC
Practice address: 123 E 2ND St
Grainfield, KS 67737-3505
Phone: (405) 301-2708
NPI assigned: Jan 24, 2024
Organization subpart: No

Authorized official

Name: Mrs. Brooke Rachelle Briggs, APRN
Title: Sole Member
Phone: (785) 953-5953

Practitioners 1

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

Brooke Rachelle Briggs, APRN Family Nurse Practitioner · Grainfield, KS · NPI 1326586637

Medicare reassignment NPD KS

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
17D2298670	Western Roots Medical Clinic, LLC 123 E 2ND St, Grainfield, KS 67737	Certificate of waiver	Feb 5, 2028

Medicare participation

Medicare fee-for-service enrollment: Enrolled in KS

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20240401001927	KS	Part B Supplier - Clinic/Group Practice	8729426457	Receives reassigned benefits from 1 practitioner Practice locations: Grainfield, KS

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician Group: 193400000X SINGLE SPECIALTY GROUP	207Q00000X			Yes

Addresses

Primary practice location

123 E 2ND St
Grainfield, KS 67737-3505

Mailing address

PO Box 21
Grainfield, KS 67737-0021
Phone (785) 953-5953

Other providers in Grainfield, KS

All providers in Grainfield, KS · Family Medicine Physician in Kansas

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2024. 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.
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.

Verify at the official NPI Registry.