NPIMap

Organization Active NPI

Satanta District Hospital and Long-Term Care

Doing business as Satanta District Hospital Clinic-Sublette

  • Rural Health Clinic/Center
  • Sublette, KS
National Provider Identifier
1881646735
Registry record updated Aug 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H-041-001 Issued in KS
Legal business name
SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE
Doing business as
Satanta District Hospital Clinic-Sublette
Practice address
301 S. Derby
Sublette, KS 67877-0398
Phone
(620) 675-2686
Fax
(620) 675-2236
NPI assigned
May 17, 2006
Last updated
Aug 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2025

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

Authorized official

Name
Tina Pendergraft
Title
Administrator
Phone
(620) 649-2761

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Rural Health Clinic/Center 261QR1300X H-041-001 KS Primary
Nurse Practitioner 363L00000X NU

Addresses

Primary practice location

301 S. Derby
Sublette, KS 67877-0398

Mailing address

PO Box 159
Satanta, KS 67870-0159
Phone (620) 675-2686

Other identifiers 2

IdentifierTypeStateIssuer
100262260AMedicaidKS
OO1272OtherKSBLUE CROS PROVIDER #

Other names 1

  • Satanta District Hospital Clinic-Sublette Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030922000007 KS Part A Provider - Rural Health Clinic 5991616054 Practice locations: Sublette, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881646735. Details of each certification follow.

Rural health clinic certification: CCN 173454

Legal name
SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE
Doing business as
SATANTA DISTRICT HOSPITAL CLINIC-SUBLETTE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 1, 1996
Last certification
May 30, 2012
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
301 S Derby St
Sublette, KS 67877-6704
Related CCNs
173454

Other NPIs with the same Medicare PAC ID 6

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

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
17D0865420Satanta Hospital Clinic Sublette Branch RH301 South Derby Street, Sublette, KS 67877Provider-performed microscopyMay 2, 2027

National Provider Directory

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
Gaila Ross Individual Corporate Officer Jan 1, 2020
Great Plains Health Alliance Inc Organization, Phillipsburg, KS Operational/Managerial Control Dec 15, 1983
Tina Pendergraft Individual Corporate Director Sep 25, 2020
W-2 Managing Employee Sep 25, 2020
Lee Miller Individual Corporate Officer Jan 1, 2020
Daniel G Palmgren Individual Corporate OfficerBoard Member May 9, 2006
David a Dellasega Individual Operational/Managerial Control Feb 19, 2013
Satanta District Hospital and Long-Term Care Organization, Satanta, KS Non-profit Operational/Managerial Control Aug 23, 2007 100%
Kevin Wagner Individual Corporate Officer Jan 1, 2020
Curt Colson Individual Corporate Director Mar 17, 2026
Marceil Cloud Individual Corporate Officer Jan 1, 2020

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Satanta District HospitalSatanta, KS, CCN 171324 Hospital Operational/Managerial Control Dec 15, 1983
Satanta District Hospital Clinic SatantaSatanta, KS, CCN 173455 Rural health clinic Operational/Managerial Control Feb 10, 2015

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756425600000",
    "number": "1881646735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 159",
            "city": "SATANTA",
            "state": "KS",
            "postal_code": "678700159",
            "telephone_number": "620-675-2686",
            "fax_number": "620-675-2236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S. DERBY",
            "city": "SUBLETTE",
            "state": "KS",
            "postal_code": "678770398",
            "telephone_number": "620-675-2686",
            "fax_number": "620-675-2236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "status": "A",
        "authorized_official_last_name": "PENDERGRAFT",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "620-649-2761"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KS",
            "license": "H-041-001",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100262260A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROS PROVIDER #",
            "identifier": "OO1272",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Satanta District Hospital Clinic-Sublette",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sublette, KS

Sources for this page

Verify at the official NPI Registry.