NPIMap

Organization Active NPI

Prairiestar Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Hutchinson, KS
National Provider Identifier
1871564534
Registry record updated Mar 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRAIRIESTAR HEALTH CENTER, INC
Practice address
2700 E 30TH Ave
Hutchinson, KS 67502
Phone
(620) 663-8484
Fax
(620) 663-9526
NPI assigned
Jan 31, 2006
Last updated
Mar 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2025

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

Authorized official

Name
Mr. Justin Bryant Anderson
Title
Chief Executive Officer
Phone
(620) 663-8484

Specialties & licenses 1

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

Addresses

Primary practice location

2700 E 30TH Ave
Hutchinson, KS 67502

Mailing address

2700 E 30TH Ave
Hutchinson, KS 67502-1242
Phone (620) 663-8484

Other identifiers 2

IdentifierTypeStateIssuer
100175060BMedicaidKS
110056OtherKANSAS BLUE CROSS BS

Other names 1

  • Community Health Center Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040628001010 KS Part B Supplier - Clinic/Group Practice 6305822560 Receives reassigned benefits from 33 practitioners
Practice locations: Hutchinson, KS
O20070809000391 KS Part A Provider - Federally Qualified Health Center (FQHC) 6305822560 Practice locations: Hutchinson, KS
O20190918000082 KS DME Supplier - Physician - OptometristDME Supplier - Optician 6305822560 Practice locations: Hutchinson, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871564534. Details of each certification follow.

Federally qualified health center certification: CCN 171824

Legal name
PRAIRIESTAR HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 10, 2007
Last certification
Oct 10, 2007
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 16, 1994 in KS
Enrollment address
2700 E 30TH Ave
Hutchinson, KS 67502-1242

National Provider Directory

National Provider Directory

Locations

1600 N Lorraine St
Ste 110
Hutchinson, KS 67501
Phone (620) 663-8484

200 W 2nd Ave
Hutchinson, KS 67501
Phone (620) 663-8484

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Myron Lynn Sasse Individual Corporate DirectorBoard of Directors Feb 1, 2021
Mitcheal Hixson Individual Corporate DirectorBoard of Directors Mar 1, 2021
Shirley J Lebien Individual Corporate DirectorBoard Member-Vice Chair Jul 14, 2014 5%
Justin Bryant Anderson Individual Corporate OfficerCeo Jan 26, 2015
W-2 Managing Employee Jan 26, 2015
Michael Shane Katz Individual Corporate Officer Jan 1, 2021
Mary Deonne Johnson Individual Corporate Officer Jan 1, 2021
Brock Alan Wells Individual Corporate DirectorBoard of Directors Jul 1, 2021
Rick Smith Individual Corporate Officer Jan 1, 2021
Chad Linn Gilbert Individual Corporate DirectorBoard of Directors Jan 1, 2022
Kathy Ireland Individual Corporate OfficerCoo Jul 1, 2007 10%
Julie Ann Blanton Individual Corporate DirectorBoard of Directors Jan 1, 2022

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741996800000",
    "number": "1871564534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 E 30TH AVE",
            "city": "HUTCHINSON",
            "state": "KS",
            "postal_code": "675021242",
            "telephone_number": "620-663-8484",
            "fax_number": "620-802-0690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 E 30TH AVE",
            "city": "HUTCHINSON",
            "state": "KS",
            "postal_code": "67502",
            "telephone_number": "620-663-8484",
            "fax_number": "620-663-9526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIESTAR HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-31",
        "last_updated": "2025-03-15",
        "certification_date": "2025-03-15",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "BRYANT",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "620-663-8484",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "KS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100175060B",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KANSAS BLUE CROSS BS",
            "identifier": "110056",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Community Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Hutchinson, KS

Sources for this page

Verify at the official NPI Registry.