Clay County Medical Center
Organization Active NPI Rural Health Clinic/Center · Clyde, KS
NPI 1801259783 · NPPES record last updated Jan 29, 2020
Key facts
- NPI
- 1801259783
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- CLAY COUNTY MEDICAL CENTER
- Practice address
- 105 N High St
Clyde, KS 66938-9428 - Phone
- (785) 446-2226
- NPI assigned
- Mar 30, 2016
- Organization subpart
- No
Authorized official
- Name
- Mr. Austin M Gillard, MHA
- Title
- Ceo
- Phone
- (785) 632-2144
Owners & managing parties with NPI records 7
Owned or controlled facilities with NPI records 5
Other NPIs on the same Medicare enrollment 6
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 8
Related certifications (CCN) 1
Facilities with the same owner 5
Practitioners 44
-
Carissa A Horton, P.A.-C
-
Linda Marie Bott, ARNP
-
Pamela D Brabec, APRN-C
-
Ryan David Brantley, P.A
-
Arnold R Cabrera, MD
-
Adam J Chase, M.D.
-
Pamela B Davis, MD
-
Wendy Lee Gibson, PMHNP
-
Austin Keith Gydesen, APRN
-
Crystal Lynn Hathorne, APRN, PMHNP-BC
-
Alya M Houghton, APRN
-
Ray E House, MD
-
Elizabeth A Koerner, M.D.
-
Patrik Charles Leonard, M.D.
-
Allie B Lohrmeyer, M.D.
-
Mindy Sue Lovendahl, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D0705884 | Clyde Family Physicians | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KS
Rural health clinic certification: CCN 178595
- Legal name
- CLAY COUNTY MEDICAL CENTER
- Doing business as
- CLYDE FAMILY PHYSICIANS
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Mar 6, 1992
- Last certification
- Dec 27, 2010
- Ownership / control type
- Non-profit – church related
- Most recent change of ownership
- Jul 1, 2016 (1 total)
- Organization structure
- Government · Non-profit
- Enrollment address
- 105 N High St
Clyde, KS 66938-9465 - Related CCNs
- 171371
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Jeffrey D Yarrow |
Corporate Officer |
Jan 9, 1989 | |
| Lori J Penner |
Corporate Officer |
Jan 1, 1991 | |
| Austin Gillard |
Corporate Officer |
May 4, 2015 | |
| W-2 Managing Employee |
May 4, 2015 | ||
| Angela Kobel |
Corporate Officer |
May 6, 2025 | |
| W-2 Managing Employee |
May 6, 2025 | ||
| Operational/Managerial Control |
May 6, 2025 | ||
| Richard H Cott |
Corporate Officer |
Jan 12, 2009 | |
| Clay County Medical Center |
5% Or Greater Direct Ownership Interest | Jul 1, 2016 | 100% |
| Operational/Managerial Control | Jul 1, 2016 | 100% | |
| Sandy M Fox |
Corporate Officer |
Jan 1, 2001 | |
| Terri L Parry |
Corporate Officer |
Jan 30, 2007 |
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Clay County Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest (5%) Operational/Managerial Control (100%) |
Jul 1, 2016 Jul 1, 2016 |
| Clay Center Family Physicians |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jul 1, 2016 Jul 1, 2016 |
| Linn Family Physicians |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jul 1, 2016 Jul 1, 2016 |
| Riley Family Physicians |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Sep 28, 2020 Sep 28, 2020 |
| Glasco Family Physicians |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Sep 1, 2021 Sep 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091020000184 | KS | Part B Supplier - Clinic/Group Practice | 6901959436 |
Receives reassigned benefits from 53 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Clyde, KS; Clay Center, KS; Riley, KS; Marysville, KS; Glasco, KS; Linn, KS |
| O20160719002491 | KS | Part a Provider - Rural Health Clinic | 6901959436 | Practice locations: Clyde, KS |
National Provider Directory
- Tax ID family
- Clay County Medical Center
Locations
105 N High St
Clyde, KS 66938
Phone (785) 446-2226
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
105 N High St
Clyde, KS 66938-9428
Mailing address
105 N High St
Clyde, KS 66938
Phone (785) 446-2226
Other names
- Clyde Family Physicians
Other providers in Clyde, KS
- City of Clyde
- Clay Center Family Physicians PA
- Clyde Development Inc
- Stephanie Rose Girard
- Lauren Hartsook
- Cathleen Joyce Kelly
- Clara Knox
All providers in Clyde, KS · Rural Health Clinic/Center in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2020. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- 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.