Active NPI
Burgess Health Center
- Community Based Hospice Care Agency
- Onawa, IA
National Provider Identifier
1013080951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- License
- NONE
- Legal business name
- BURGESS HEALTH CENTER
- Practice address
- 1600 Diamond St
Onawa, IA 51040-1548 - Phone
- (712) 423-9265
- Fax
- (712) 423-9199
- NPI assigned
- Nov 16, 2006
- Organization subpart
- Yes
- Parent organization
- BURGESS HEALTH CENTER
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lynn R Wold
- Title
- Ceo
- Phone
- (712) 423-2311
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | NONE | IA | Primary |
| Community Based Hospice Care Agency | 251G00000X | HOSPICE 7 | NE |
Addresses
Primary practice location
1600 Diamond St
Onawa, IA 51040-1548
Mailing address
1600 Diamond St
Onawa, IA 51040-1548
Phone (712) 423-2311
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0615393 | Medicaid | IA | |
| 100251727-00 | Medicaid | NE | |
| 61539 | Other | IA | BCBC HOSPICE |
Other names 1
- Burgess Hospice
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031219000549 | IA | Part B Supplier - Clinic/Group Practice | 0143131516 |
Receives reassigned benefits from 27 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Onawa, IA |
| O20100309000300 | IA | Part A Provider - Hospice | 0143131516 | Practice locations: Onawa, IA |
Hospice certification: CCN 161539
- Legal name
- BURGESS HEALTH CENTER
- Doing business as
- BURGESS HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Mar 9, 1995
- Last certification
- Jun 30, 2021
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- Corporation
- Incorporated
- Apr 16, 1959 in IA
- Enrollment address
- 1600 Diamond St
Onawa, IA 51040-1548
Other NPIs with the same Medicare PAC ID 6
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 7
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
Care Compare: Hospice
Medicare Care Compare- Listed as
- Burgess Hospice
- Ownership
- Non-Profit
- Certified
- Mar 9, 1995
- Medicare certification status
- Active
National Provider Directory
National Provider Directory- Part of
- Burgess Health Center
Interoperability endpoints
- https://fhir-usa.unify.chbase.com/org/burgess-c3678f43
Ownership & related parties
All disclosed owners & managing parties 14
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Andrew Tirevold | Corporate Director | Oct 26, 2020 | |
| Rachel M Martian | W-2 Managing Employee | Sep 27, 2022 | |
| Operational/Managerial Control | Sep 27, 2022 | ||
| Beau T Hupke | Corporate Director | Apr 22, 2024 | |
| Shelia M Duarte | Corporate Director | Jan 27, 2014 | |
| Jeffrey R Pratt | Corporate Director | Apr 22, 2024 | |
| Lynn R Wold | Corporate Officer | Jul 31, 2023 | |
| W-2 Managing Employee | Jul 31, 2023 | ||
| Operational/Managerial Control | Jul 31, 2023 | ||
| Terry Murrell | Corporate Director | Jan 23, 2023 | |
| James L Gobell | W-2 Managing Employee | Oct 2, 2023 | |
| Operational/Managerial Control | Oct 2, 2023 | ||
| Allison L Kovar | Contracted Managing Employee | Aug 15, 2011 | |
| Operational/Managerial Control | Aug 15, 2011 | ||
| Mari B Miller | Corporate Officer | Aug 5, 2019 | |
| Corporate Director | Jun 25, 2007 | ||
| Keith a Schrunk | Corporate Officer | Jun 29, 2020 | |
| Corporate Director | Apr 23, 2012 | ||
| Paul E Dudley | Corporate Director | Jun 22, 2009 | |
| Amy Maule | Corporate Officer | Mar 29, 2023 | |
| Corporate Director | Oct 26, 2020 | ||
| Matthew Minnihan | Corporate Director | Jan 23, 2023 |
Owners & managing parties with NPI records 4
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Medicine Physician
- Onawa, IA
- NPI 1942468111
Contracted Managing Employee, Operational/Managerial Control
Practitioners & affiliated clinicians
Affiliated clinicians 5
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163635200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1720483200000",
"number": "1013080951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 DIAMOND ST",
"city": "ONAWA",
"state": "IA",
"postal_code": "510401548",
"telephone_number": "712-423-2311",
"fax_number": "712-423-9199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 DIAMOND ST",
"city": "ONAWA",
"state": "IA",
"postal_code": "510401548",
"telephone_number": "712-423-9265",
"fax_number": "712-423-9199"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BURGESS HEALTH CENTER",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BURGESS HEALTH CENTER",
"enumeration_date": "2006-11-16",
"last_updated": "2024-07-09",
"certification_date": "2024-07-09",
"status": "A",
"authorized_official_last_name": "WOLD",
"authorized_official_first_name": "LYNN",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "712-423-2311"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "IA",
"license": "NONE",
"primary": true
},
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "NE",
"license": "HOSPICE 7",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0615393",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100251727-00",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBC HOSPICE",
"identifier": "61539",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Burgess Hospice",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Burgess Hospice",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Onawa, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.