Integris Bass Baptist Health Center
Organization Active NPI Family Medicine Physician · Caldwell, KS
NPI 1942201397 · NPPES record last updated Mar 29, 2022
Key facts
- NPI
- 1942201397
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- INTEGRIS BASS BAPTIST HEALTH CENTER
- Practice address
- 415 S Osage St
Caldwell, KS 67022-1650 - Phone
- (620) 845-2516
- NPI assigned
- Aug 9, 2005
- Organization subpart
- No
Authorized official
- Name
- Chris Hammes
- Title
- Senior Vice President & Coo
- Phone
- (405) 949-3402
Other NPIs on the same Medicare enrollment 17
Change of ownership 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Jul 1, 2022 | Change of Ownership |
Caldwell Family Clinic |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031103000717 | OK | Part B Supplier - Clinic/Group Practice | 0345151981 |
Receives reassigned benefits from 28 practitioners 17 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Medford, OK; Hennessey, OK; Enid, OK |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
415 S Osage St
Caldwell, KS 67022-1650
Mailing address
5400 N Independence Ave Ste 200
Oklahoma City, OK 73112-5300
Phone (405) 713-5515
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100755850B | Other | OK | OK MEDICAID FFS |
| 100100440 C | Other | KS | KS MEDICAID RHC |
| 100193490E | Other | OK | OK MEDICAID SC |
| 100699500P | Other | OK | OK MEDICAID RHC |
| 100699500P | Medicaid | OK | |
| 100100440 D | Other | KS | KS MEDICAID FFS |
| 460169 | Other | KS | KS RHC CHILD MERCY |
Other names
- INTEGRIS Caldwell Family Clinic
Other providers in Caldwell, KS
- Caldwell Pharmacy Inc
- Caldwell Pharmacy Inc
- Goodrick Home Care
- Joe Halling
- Harold a Small DDS PA
- Ali Lee
- Aidan Moreland
- Cooper L Nickel
- Molly Kay Partee
- Mary Elizabeth Petrik
All providers in Caldwell, KS · Family Medicine Physician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.