NPIMap

Organization Active NPI

Community Health Center of Southeast Kansas, Inc.

  • Federally Qualified Health Center (FQHC)
  • Humboldt, KS
National Provider Identifier
1801643200
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
Practice address
1216 Hawaii Rd
Humboldt, KS 66748-1390
Phone
(620) 473-1002
NPI assigned
May 2, 2024
Last updated
May 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2024

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

Authorized official

Name
Daniel Spencer Creitz
Title
Cco
Phone
(620) 240-5015

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1216 Hawaii Rd
Humboldt, KS 66748-1390

Mailing address

PO Box 1832
Pittsburg, KS 66762-1832

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040209000163 KS Part B Supplier - Clinic/Group Practice 7911816392 Receives reassigned benefits from 184 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Parsons, KS; Pleasanton, KS; Pittsburg, KS; Mound City, KS; La Cygne, KS; Iola, KS; Independence, KS; Garnett, KS…
O20240620001778 KS Part A Provider - Federally Qualified Health Center (FQHC) 7911816392 Practice locations: Humboldt, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801643200. Details of each certification follow.

Federally qualified health center certification: CCN 171026

Legal name
COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 19, 2024
Last certification
Jun 19, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 20, 2001 in KS
Enrollment address
1216 Hawaii Rd
Humboldt, KS 66748-1390

Other NPIs on the same Medicare enrollment 23

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

View all 23

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D2299242Community Health Center of Southeast Kansas1216 Hawaii Rd, Humboldt, KS 66748Certificate of waiverFeb 14, 2028

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center of Southeast Kanas Inc43 organizations share this tax ID, including this one

Other organizations with this tax ID 42

Organizations that report the same tax identification number in the National Provider Directory.

View all 42

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Rachel Ruiz Individual Corporate OfficerBoard Member Jan 1, 2023
Krista Kay Postai Individual Corporate DirectorCeo Nov 2, 2004
W-2 Managing EmployeeAd; Nov 2, 2004
David Shepherd Individual Corporate OfficerTreasurer Apr 18, 2019
Nancy Haire Individual Corporate OfficerSecretary Nov 1, 2021
Judy a. Westhoff Individual Corporate OfficerBoard Member Nov 1, 2002
Travis Wilson Individual Corporate OfficerBoard Member Jan 1, 2023
Brian Jones Individual Corporate Officer Nov 1, 2007
Sandra Cobos Cenobio Individual Corporate OfficerBoard Member Apr 20, 2023
Shawn Naccarato Individual Corporate Officer Aug 20, 2020
Jason M Wesco Individual Corporate DirectorPresident Jan 1, 2021
W-2 Managing EmployeeAd; Jan 1, 2021
Dawn Flores Individual Corporate OfficerVice Chair Nov 1, 2005
Daniel Creitz Individual Corporate DirectorSenior Vice President Jan 1, 2022
W-2 Managing Employee Jan 1, 2022
John Wyrick Individual Corporate OfficerBoard Member Nov 1, 2016
Ginger Nance Individual Corporate OfficerBoard Member Nov 1, 2022
Community Health Center of Southeast Kansas Inc Organization, Pittsburg, KS Non-profit Operational/Managerial Control Apr 1, 2024
Jake Letner Individual Corporate OfficerChair Jun 1, 2021
Alysia Johnston Individual Corporate Officer Nov 1, 2023
Patrick O'Bryan Individual Corporate OfficerBoard Member Nov 1, 2017

All facility ownership & control disclosures 18

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Community Health Center of Southeast Kansas IncCoffeyville, KS, CCN 171840 Federally qualified health center Operational/Managerial Control (100%) Nov 15, 2011
Community Health Center of Southeast Kansas/CoffeyvilleCoffeyville, KS, CCN 171842 Federally qualified health center Operational/Managerial Control (100%) Jan 2, 2012
Community Health Center of Southeast Kansas/IolaIola, KS, CCN 171846 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2008
CHC/Sek's Field Kindley Student Health CenterCoffeyville, KS, CCN 171849 Federally qualified health center Operational/Managerial Control Oct 15, 2013
Community Health Center of Southeast Kansas IncIndependence, KS, CCN 171850 Federally qualified health center Operational/Managerial Control (100%) Jun 2, 2014
Community Health Center of Southeast Kansas/ParsonsParsons, KS, CCN 171861 Federally qualified health center Operational/Managerial Control (100%) Aug 31, 2015
Community Health Center of Southeast Kansas/PleasantonPleasanton, KS, CCN 171885 Federally qualified health center Operational/Managerial Control (100%) Dec 31, 2018
CHC/Sek Arma ClinicArma, KS, CCN 171886 Federally qualified health center Operational/Managerial Control (100%) Dec 31, 2018
Community Health Center of Southeast Kansas Inc/Fort Scott Main ClinicFort Scott, KS, CCN 171887 Federally qualified health center Operational/Managerial Control (100%) Dec 31, 2018
Community Health Center of Southeast Kansas/Mound CityMound City, KS, CCN 171889 Federally qualified health center Operational/Managerial Control (100%) Dec 31, 2018
CHC/Ok Miami ClinicMiami, OK, CCN 371945 Federally qualified health center Operational/Managerial Control Nov 20, 2019
Community Health Center of Southeast Kansas IncPittsburg, KS, CCN 171891 Federally qualified health center Operational/Managerial Control Oct 17, 2018
CHC/Sek South PittsburgPittsburg, KS, CCN 171895 Federally qualified health center Operational/Managerial Control Apr 17, 2020
Community Health Center of Southeast Kansas IncLa Cygne, KS, CCN 171905 Federally qualified health center Operational/Managerial Control (100%) Sep 24, 2021
Community Health Center of Southeast Kansas IncColumbus, KS, CCN 171017 Federally qualified health center Operational/Managerial Control (100%) Nov 7, 2022
Community Health Center of Southeast Kansas IncBaxter Springs, KS, CCN 171018 Federally qualified health center Operational/Managerial Control (100%) Feb 1, 2023
Community Health Center of Southeast Kansas IncIola, KS, CCN 171019 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2023
Community Health Center of Southeast Kansas IncPittsburg, KS, CCN 171024 Federally qualified health center Operational/Managerial Control Aug 1, 2023

Facilities with the same owner 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1714608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714608000000",
    "number": "1801643200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1832",
            "city": "PITTSBURG",
            "state": "KS",
            "postal_code": "667621832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 HAWAII RD",
            "city": "HUMBOLDT",
            "state": "KS",
            "postal_code": "667481390",
            "telephone_number": "620-473-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-02",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A",
        "authorized_official_last_name": "CREITZ",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "SPENCER",
        "authorized_official_title_or_position": "CCO",
        "authorized_official_telephone_number": "620-240-5015"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Humboldt, KS

Sources for this page

Verify at the official NPI Registry.