NPIMap

Organization Active NPI

Jewell County Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Mankato, KS
National Provider Identifier
1811925290
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
H045001 Issued in KS
Legal business name
JEWELL COUNTY HOSPITAL
Practice address
100 Crestvue Ave
Mankato, KS 66956-2407
Phone
(785) 378-3137
Fax
(785) 378-3450
NPI assigned
Jun 28, 2006
Last updated
Jun 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

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

Authorized official

Name
Barry Bottger
Title
Cfo
Phone
(785) 378-3137

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X H045001 KS Primary

Addresses

Primary practice location

100 Crestvue Ave
Mankato, KS 66956-2407

Mailing address

100 Crestvue Ave
Mankato, KS 66956-2407
Phone (785) 378-3137

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070206000345 KS Part A Provider - Critical Access Hospital 7911818273 Practice locations: Mankato, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811925290. Details of each certification follow.

Hospital certification: CCN 17Z309

Legal name
JEWELL COUNTY HOSPITAL
Organization structure
OtherProprietary
Enrollment address
100 Crestvue Ave
Mankato, KS 66956-2407
Main/Primary Hospital Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Jewell Co Rural Health3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the 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 10

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

NameRoleSinceShare
Leland Tice Individual Corporate DirectorBoard Member Jan 1, 2023
Kendall Nelson Individual Corporate DirectorBoard Member Jan 1, 2023
Barry Kent Bottger Individual Corporate OfficerCfo Jan 1, 2023
Steven Greene Individual Corporate DirectorBoard Member Jan 1, 2023
Mark Fleming Individual Corporate OfficerBoard Member Mar 12, 2025
Doyle L McKimmy Individual Corporate OfficerCeo May 21, 2007
W-2 Managing Employee May 21, 2007
Operational/Managerial ControlCeo May 21, 2007
Elizabeth McKain Individual Corporate Director Jan 1, 2023
W-2 Managing Employee Jan 1, 2023
D'Ann Gardner Individual W-2 Managing Employee Jan 1, 2023
County of Jewell Organization, Mankato, KS 5% Or Greater Direct Ownership Interest Mar 1, 1996 100%
Cynthia Clark Individual Corporate DirectorBoard Member Jan 1, 2023

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 Jewell

    dba Jewell County EMS

    • Land Ambulance
    • Mankato, KS
    • NPI 1275519613

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Jewell

    dba Jewell County Health Department

    • Public Health or Welfare Agency
    • Mankato, KS
    • NPI 1760487656

    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

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719360000000",
    "number": "1811925290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CRESTVUE AVE",
            "city": "MANKATO",
            "state": "KS",
            "postal_code": "669562407",
            "telephone_number": "785-378-3137",
            "fax_number": "785-378-3450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CRESTVUE AVE",
            "city": "MANKATO",
            "state": "KS",
            "postal_code": "669562407",
            "telephone_number": "785-378-3137",
            "fax_number": "785-378-3450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEWELL COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-28",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A",
        "authorized_official_last_name": "BOTTGER",
        "authorized_official_first_name": "BARRY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "785-378-3137"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "KS",
            "license": "H045001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mankato, KS

Sources for this page

Verify at the official NPI Registry.