NPIMap

Organization Active NPI

Family Practice Associates of Western Kansas, LLC

Doing business as Family Practice Associates

  • Rural Health Clinic/Center
  • Dodge City, KS
National Provider Identifier
1841255437
Registry record updated Oct 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAMILY PRACTICE ASSOCIATES OF WESTERN KANSAS, LLC
Doing business as
Family Practice Associates
Practice address
120 W Ross Blvd
Dodge City, KS 67801-2131
Phone
(620) 225-1650
Fax
(620) 227-2505
NPI assigned
Apr 18, 2006
Last updated
Oct 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2021

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

Authorized official

Name
Roger C Trotter, MDNPI 1548225121
Title
Partner
Phone
(620) 225-1650

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

120 W Ross Blvd
Dodge City, KS 67801-2131

Mailing address

120 W Ross Blvd
Dodge City, KS 67801-2131
Phone (620) 225-1650

Other identifiers 3

IdentifierTypeStateIssuer
100388180AMedicaidKS
100388180CMedicaidKS
110630OtherKSBCBS

Other names 1

  • Family Practice Associates Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030415000012 KS Part A Provider - Rural Health Clinic 5698684512 Practice locations: Dodge City, KS
O20060109001079 KS Part B Supplier - Clinic/Group Practice 5698684512 Receives reassigned benefits from 8 practitioners
Practice locations: Dodge City, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841255437. Details of each certification follow.

Rural health clinic certification: CCN 178966

Legal name
FAMILY PRACTICE ASSOCIATES OF WESTERN KANSAS, LLC
Doing business as
FAMILY PRACTICE ASSOCIATES OF WESTERN KANSAS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 26, 2003
Last certification
Feb 25, 2026
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Feb 22, 2000 in KS
Enrollment address
120 W Ross Blvd
Dodge City, KS 67801-2131

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
17D0863612Family Practice Associates120 Ross Blvd, Dodge City, KS 67801Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Roger C Trotter Individual 5% Or Greater Direct Ownership Interest Jan 1, 2001
General Partnership Interest Jan 1, 2000
Corporate Director Apr 15, 2003
Operational/Managerial Control Jan 1, 2001 20%
Glenda Smith Individual W-2 Managing EmployeeOffice Manager Jan 1, 2001
Jeremy J Presley Individual 5% Or Greater Direct Ownership InterestPartner Aug 1, 2011 20%
General Partnership Interest Aug 1, 2011
Merrill Ray Conant Individual Corporate Director Apr 15, 2003

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634515200000",
    "number": "1841255437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 W ROSS BLVD",
            "city": "DODGE CITY",
            "state": "KS",
            "postal_code": "678012131",
            "telephone_number": "620-225-1650",
            "fax_number": "620-227-2505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 W ROSS BLVD",
            "city": "DODGE CITY",
            "state": "KS",
            "postal_code": "678012131",
            "telephone_number": "620-225-1650",
            "fax_number": "620-227-2505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PRACTICE ASSOCIATES OF WESTERN KANSAS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-18",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A",
        "authorized_official_last_name": "TROTTER",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "620-225-1650",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100388180A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100388180C",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "110630",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Practice Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Practice Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dodge City, KS

Sources for this page

Verify at the official NPI Registry.