NPIMap

Organization Active NPI

Virginia Gay Hospital, Inc

  • Rural Health Clinic/Center
  • Urbana, IA
National Provider Identifier
1003859620
Registry record updated Sep 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
VIRGINIA GAY HOSPITAL, INC
Practice address
1002 W Main St
Urbana, IA 52345-9099
Phone
(319) 443-5000
NPI assigned
Jun 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2016

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

Authorized official

Name
Michael J Riege
Title
Administrator
Phone
(319) 443-5000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1002 W Main St
Urbana, IA 52345-9099

Mailing address

1002 W Main St
Urbana, IA 52345-9099
Phone (319) 443-5000

Other identifiers 1

IdentifierTypeStateIssuer
5056994MedicaidIA

Other names 1

  • Urbana Family Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090729000247 IA Part A Provider - Rural Health Clinic 1759290331 Practice locations: Urbana, IA

Rural health clinic certification: CCN 163485

Legal name
VIRGINIA GAY HOSPITAL INC
Doing business as
URBANA FAMILY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 18, 2002
Last certification
Feb 4, 2021
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Enrollment address
1002 W Main St
Urbana, IA 52345-9099
Related CCNs
161349

Facilities connected through Provider of Services related, parent or unit certification numbers.

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
16D0996668Urbana Family Medical Clinic1002 West Main Street, Urbana, IA 52345Provider-performed microscopyFeb 24, 2028

National Provider Directory

National Provider Directory
Tax ID family
Virginia Gay Hospital10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
John F. Yundt Individual Corporate OfficerChairperson Oct 20, 2009
Corporate DirectorTreasurer Nov 1, 2001
W-2 Managing EmployeeCeo Jun 15, 1992
Operational/Managerial ControlCeo Jun 15, 1992
Virginia Gay Hospital Inc Organization, Urbana, IA Corporation Operational/Managerial Control Jun 15, 1992
John Mossman Individual Corporate OfficerBoard Member Jan 1, 2019
David Homer Vermedahl Individual Corporate OfficerSecretary Nov 1, 2004
Corporate DirectorSecretary Nov 1, 2001
Kyle Koeppen Individual Corporate OfficerBoard Member Oct 1, 2021
Tina M Eden Individual Corporate OfficerCeo Apr 1, 2025
W-2 Managing EmployeeAd;Ceo Apr 1, 2025
Operational/Managerial ControlCeo Apr 1, 2025
Sara S Stuefen Individual Corporate OfficerSecretary Jan 1, 2019
Corporate DirectorSecretary Jan 1, 2019
Max Maynard Individual Corporate DirectorBoard Member Jan 1, 2018
Barry W Dietsch Individual Corporate OfficerCfo Jul 8, 2014
W-2 Managing EmployeeCfo Jul 8, 2014
Operational/Managerial ControlCfo Jul 8, 2014
Brian W Meeker Individual Corporate DirectorBoard Member Jun 19, 1995
Michelle M Elgin Individual Corporate DirectorBoard Member Sep 17, 2013
Marie T Foth Individual Corporate DirectorBoard Member Oct 20, 2009

Owners & managing parties with NPI records 8

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
Virginia Gay Hospital Home HealthVinton, IA, CCN 167063 Home health agency Operational/Managerial Control (100%) Dec 15, 1994
Atkins Family Medical ClinicAtkins, IA, CCN 168556 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 20, 2012
Aug 20, 2012

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 2

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

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474502400000",
    "number": "1003859620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 W MAIN ST",
            "city": "URBANA",
            "state": "IA",
            "postal_code": "523459099",
            "telephone_number": "319-443-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 W MAIN ST",
            "city": "URBANA",
            "state": "IA",
            "postal_code": "523459099",
            "telephone_number": "319-443-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRGINIA GAY HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2016-09-22",
        "status": "A",
        "authorized_official_last_name": "RIEGE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "319-443-5000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5056994",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Urbana Family Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Urbana, IA

Sources for this page

Verify at the official NPI Registry.