NPIMap

Organization Active NPI

Loring Hospital

  • Certified Registered Nurse Anesthetist
  • Sac City, IA
National Provider Identifier
1003965336
Registry record updated Jun 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
LORING HOSPITAL
Practice address
211 Highland Ave
Sac City, IA 50583-2416
Phone
(712) 662-7105
Fax
(712) 662-3297
NPI assigned
Jan 9, 2007
Organization subpart
Yes
Parent organization
LORING HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 5, 2023

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

Authorized official

Name
Matthew D Johnson
Title
Ceo
Phone
(712) 662-7105

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

211 Highland Ave
Sac City, IA 50583-2416

Mailing address

211 Highland Ave
Sac City, IA 50583-2416
Phone (712) 662-7105

Other identifiers 2

IdentifierTypeStateIssuer
30179OtherIABCBS CRNA PROVIDER SERV
0135574MedicaidIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080313000229 IA Part B Supplier - Clinic/Group Practice 1052379625 Receives reassigned benefits from 22 practitioners
Practice locations: Sac City, IA

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Loring Hospital4 organizations share this tax ID, including this one
Part of
Loring Hospital

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685923200000",
    "number": "1003965336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 HIGHLAND AVE",
            "city": "SAC CITY",
            "state": "IA",
            "postal_code": "505832416",
            "telephone_number": "712-662-7105",
            "fax_number": "712-662-3297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 HIGHLAND AVE",
            "city": "SAC CITY",
            "state": "IA",
            "postal_code": "505832416",
            "telephone_number": "712-662-7105",
            "fax_number": "712-662-3297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LORING HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LORING HOSPITAL",
        "enumeration_date": "2007-01-09",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-662-7105"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS CRNA PROVIDER SERV",
            "identifier": "30179",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0135574",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sac City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.