Hillsboro Hospital LLC
Organization Active NPI Rural Health Clinic/Center · Hillsboro, KS
NPI 1982242152 · NPPES record last updated Dec 18, 2019
Key facts
- NPI
- 1982242152
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- HILLSBORO HOSPITAL LLC
- Practice address
- 101 Industrial Rd
Hillsboro, KS 67063-9602 - Phone
- (620) 947-3114
- NPI assigned
- Dec 18, 2019
- Organization subpart
- No
Authorized official
- Name
- Darrel Morris
- Title
- Coo
- Phone
- (918) 527-1234
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 2
Related certifications (CCN) 1
Change of ownership 1
Facilities with the same owner 11
Practitioners 15
-
Kasie Gant, APRN, FNP-C
-
Stephen G Grillot, D.O.
-
Lisa Melton, APRN
-
Jason H Burk, CRNA, FNP-C, PMHNP
-
Charlene M McDonald, CRNA
-
Alyssa Ann Reimer, PA-C
-
Nicole Sayed, APRN
-
Sonia Slaba, CRNA
-
Joshua L. Smith, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Rural health clinic certification: CCN 178567
- Legal name
- HILLSBORO HOSPITAL LLC
- Doing business as
- HILLSBORO CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 20, 2011
- Last certification
- Oct 5, 2020
- Ownership / control type
- 1B
- Most recent change of ownership
- Dec 9, 2019 (1 total)
- Organization structure
- LLC · Proprietary
- Enrollment address
- 101 Industrial Rd
Hillsboro, KS 67063-9602 - Related CCNs
- 171357
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Darrel W Morris |
5% Or Greater Indirect Ownership Interest |
Dec 9, 2019 | 16.22% |
| Corporate Officer |
Dec 9, 2019 | 16.22% | |
| Corporate Director |
Dec 9, 2019 | 16.22% | |
| Operational/Managerial Control |
Dec 9, 2019 | 16.22% | |
| RHG Consolidated LLC |
5% Or Greater Direct Ownership Interest | Dec 9, 2019 | 100% |
| Operational/Managerial Control | Dec 9, 2019 | 100% | |
| Phyllis Shaffer |
Corporate Director |
Jan 1, 2025 | 6.08% |
| Lawrence J Arthur |
5% Or Greater Indirect Ownership Interest | Dec 9, 2019 | 16.67% |
| Trent M Skaggs |
5% Or Greater Indirect Ownership Interest |
Dec 9, 2019 | 16.67% |
| Corporate Officer |
Dec 9, 2019 | 16.67% | |
| Corporate Director |
Dec 9, 2019 | 16.67% | |
| Operational/Managerial Control |
Dec 9, 2019 | 16.67% | |
| LG Medical LLC |
5% Or Greater Indirect Ownership Interest | Jan 1, 2025 | 12.97% |
| Brent Lagergren |
5% Or Greater Indirect Ownership Interest |
Dec 9, 2019 | 6.09% |
| Corporate Officer |
Dec 9, 2019 | 6.09% | |
| Billy W May |
5% Or Greater Indirect Ownership Interest |
Dec 9, 2019 | 5.63% |
| Corporate Officer |
Dec 9, 2019 | 5.63% | |
| Corporate Director | Dec 9, 2019 | 5.63% | |
| Dennis L Davis |
5% Or Greater Indirect Ownership Interest |
Dec 9, 2019 | 16.67% |
| Jami Homfeld |
5% Or Greater Indirect Ownership Interest | Jan 1, 2025 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Dec 9, 2019 | Change of Ownership |
Hillsboro Clinic |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200219000430 | KS | Part a Provider - Rural Health Clinic | 4587090121 | Practice locations: Hillsboro, KS |
National Provider Directory
- Tax ID family
- Hillsboro Hospital LLC
Locations
101 Industrial Rd
Hillsboro, KS 67063
Phone (620) 877-4165
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
101 Industrial Rd
Hillsboro, KS 67063-9602
Mailing address
101 Industrial Rd
Hillsboro, KS 67063-9602
Phone (620) 947-3114
Other names
- Hillsboro Community Hospital
Other providers in Hillsboro, KS
- Michelle Lynn Hilger
- Hillsboro Dental Care LLC
- Hillsboro Hospital LLC
- Hillsboro Hospital LLC
- Hillsboro Hospital LLC
- Rachael Nichole Holz
- Jessica M Hughbanks
- Briana Kaelis Jamieson
- Shauna Marie Kern
- Dana Knox
All providers in Hillsboro, KS · Rural Health Clinic/Center in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2019. 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.