NPIMap

Organization Active NPI

Wilson County Hospital

Doing business as Wilson Medical Center Professional

  • Nurse Practitioner
  • Neodesha, KS
National Provider Identifier
1992842942
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
H103002 Issued in KS
Legal business name
WILSON COUNTY HOSPITAL
Doing business as
Wilson Medical Center Professional
Practice address
2600 Ottawa Rd
Neodesha, KS 66757-1897
Phone
(620) 325-2611
Fax
(620) 325-8459
NPI assigned
Jan 31, 2007
Last updated
Sep 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Authorized official

Name
Lori C Smith
Title
Cfo
Phone
(620) 325-8388

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X H103002 KS Primary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X H103002 KS

Addresses

Primary practice location

2600 Ottawa Rd
Neodesha, KS 66757-1897

Mailing address

PO Box 360
Neodesha, KS 66757-0360
Phone (620) 325-2611

Other names 1

  • Wilson Medical Center Professional Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041119000995 KS Part B Supplier - Clinic/Group Practice 0042273971 Receives reassigned benefits from 22 practitioners
2 other NPIs on this enrollment
Practice locations: Cherryvale, KS; Independence, KS; Neodesha, KS

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Independence Family MedicineIndependence, KS, CCN 178582 Rural health clinic Operational/Managerial Control May 20, 2013
Neodesha Family MedicineNeodesha, KS, CCN 178610 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2017

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727222400000",
    "number": "1992842942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 360",
            "city": "NEODESHA",
            "state": "KS",
            "postal_code": "667570360",
            "telephone_number": "620-325-2611",
            "fax_number": "620-325-8453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 OTTAWA RD",
            "city": "NEODESHA",
            "state": "KS",
            "postal_code": "667571897",
            "telephone_number": "620-325-2611",
            "fax_number": "620-325-8459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "620-325-8388"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "KS",
            "license": "H103002",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KS",
            "license": "H103002",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilson Medical Center Professional",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Neodesha, KS

Sources for this page

Verify at the official NPI Registry.