NPIMap

Organization Active NPI

Hodgeman County Health Center

Doing business as o;shea memorial clinic

  • Clinic/Center
  • Jetmore, KS
National Provider Identifier
1790777324
Registry record updated Nov 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
HODGEMAN COUNTY HEALTH CENTER
Doing business as
o;shea memorial clinic
Practice address
810 W Bramley St
Jetmore, KS 67854-9320
Phone
(620) 357-8354
Fax
(620) 357-6460
NPI assigned
Aug 19, 2005
Last updated
Nov 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2022

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

Authorized official

Name
Stacey Briggs
Title
Cfo
Phone
(620) 357-8361

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

810 W Bramley St
Jetmore, KS 67854-9320

Mailing address

PO Box 310
Jetmore, KS 67854-0310
Phone (620) 357-8354

Other names 1

  • o;shea memorial clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030922000028 KS Part A Provider - Rural Health Clinic 5799696894 Practice locations: Jetmore, KS
O20041012000779 KS Part B Supplier - Clinic/Group Practice 5799696894 Receives reassigned benefits from 20 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jetmore, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790777324. Details of each certification follow.

Rural health clinic certification: CCN 173992

Legal name
HODGEMAN COUNTY HEALTH CENTER
Doing business as
O'SHEA MEMORIAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 1992
Last certification
Oct 28, 2009
Ownership / control type
2C
Organization structure
OtherNon-profit
Enrollment address
810 W Bramley St
Jetmore, KS 67854-9320
Related CCNs
173992

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 1

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to 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
Sidni Durler Individual W-2 Managing Employee Jan 1, 2025
Stacey Briggs Individual W-2 Managing EmployeeCfo Jul 30, 2025
County of Hodgeman Organization, Jetmore, KS 5% Or Greater Direct Ownership Interest Apr 12, 1970 100%

Owners & managing parties with NPI records 2

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

  • County of Hodgeman

    dba Hodgeman County Ambulance

    • Land Ambulance
    • Jetmore, KS
    • NPI 1770673733

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Hodgeman

    dba Hodgeman County Health Dept

    • Public Health or Welfare Agency
    • Jetmore, KS
    • NPI 1902853815

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667865600000",
    "number": "1790777324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 310",
            "city": "JETMORE",
            "state": "KS",
            "postal_code": "678540310",
            "telephone_number": "620-357-8354",
            "fax_number": "620-357-6460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 W BRAMLEY ST",
            "city": "JETMORE",
            "state": "KS",
            "postal_code": "678549320",
            "telephone_number": "620-357-8354",
            "fax_number": "620-357-6460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HODGEMAN COUNTY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-19",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A",
        "authorized_official_last_name": "BRIGGS",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "620-357-8361"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "o;shea memorial clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "o;shea memorial clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jetmore, KS

Sources for this page

Verify at the official NPI Registry.