NPIMap

Organization Active NPI

Burgess Health Center

  • Rural Health Clinic/Center
  • Sloan, IA
National Provider Identifier
1013243633
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BURGESS HEALTH CENTER
Practice address
409 Evans St
Sloan, IA 51055-7748
Phone
(712) 428-4100
Fax
(712) 428-4102
NPI assigned
Nov 2, 2009
Organization subpart
Yes
Parent organization
BURGESS HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X IA
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X IA
Rural Health Clinic/Center 261QR1300X IA Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X IA

Addresses

Primary practice location

409 Evans St
Sloan, IA 51055-7748

Mailing address

1600 Diamond St
Onawa, IA 51040-1548
Phone (712) 423-2311

Other identifiers 1

IdentifierTypeStateIssuer
0634865MedicaidIA

Other names 1

  • Burgess Family Clinic - Sloan Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100903000429 IA Part A Provider - Rural Health Clinic 0143131516 Practice locations: Sloan, IA

Rural health clinic certification: CCN 163483

Legal name
BURGESS HEALTH CENTER
Doing business as
BURGESS FAMILY CLINIC - SLOAN
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 20, 2001
Last certification
Dec 24, 2024
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Apr 16, 1959 in IA
Enrollment address
409 Evans St
Sloan, IA 51055-7748
Related CCNs
161359

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
16D0900562Burgess Family Clinic - Sloan409 Evans Street, PO Box 447, Sloan, IA 51055Provider-performed microscopyJun 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Burgess Health Center2 organizations share this tax ID, including this one
Part of
Burgess Health Center

Other organizations with this tax ID 1

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

Locations

621 Iowa Ave
Dunlap, IA 51529

111 S 5th St
Mapleton, IA 51034
Phone (712) 882-2234

513 S Muckey St
Mapleton, IA 51034
Phone (712) 880-0222

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Andrew Tirevold Individual Corporate Director Oct 26, 2020
Beau T Hupke Individual Corporate Director Apr 22, 2024
Shelia M Duarte Individual Corporate Director Jan 27, 2014
Jeffrey R Pratt Individual Corporate Director Apr 22, 2024
Lynn R Wold Individual Corporate OfficerCeo Jul 31, 2023
W-2 Managing EmployeeCeo Jul 31, 2023
Operational/Managerial ControlCeo Jul 31, 2023
Lynn L Charrlin Individual W-2 Managing EmployeeMD; Sep 14, 2017
Operational/Managerial ControlMedical Director Sep 14, 2017
Terry Murrell Individual Corporate Director Jan 23, 2023
James L Gobell Individual W-2 Managing EmployeeVice President of Finance Oct 2, 2023
Operational/Managerial ControlVice President of Finance Oct 2, 2023
Mari B Miller Individual Corporate Officer Aug 5, 2019
Corporate Director Jun 25, 2007
Justin Hummelgard Individual W-2 Managing EmployeeAd;Clinic Director Jul 28, 2020
Operational/Managerial ControlClinic Director Jul 28, 2020
Keith a Schrunk Individual Corporate Officer Jun 29, 2020
Corporate Director Apr 23, 2012
Teresa Butler Individual W-2 Managing EmployeeVice President of Clinical Services Sep 24, 2012
Operational/Managerial ControlVice President of Clinical Services Sep 24, 2012
Paul E Dudley Individual Corporate Director Jun 22, 2009
Amy Maule Individual Corporate Officer Mar 29, 2023
Corporate Director Oct 26, 2020
Matthew Minnihan Individual 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.

Practitioners & affiliated clinicians

Practitioners 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1257120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1013243633",
    "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": "409 EVANS ST",
            "city": "SLOAN",
            "state": "IA",
            "postal_code": "510557748",
            "telephone_number": "712-428-4100",
            "fax_number": "712-428-4102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURGESS HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BURGESS HEALTH CENTER",
        "enumeration_date": "2009-11-02",
        "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": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IA",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "IA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0634865",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Burgess Family Clinic - Sloan",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Burgess Family Clinic - Sloan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sloan, IA

Sources for this page

Verify at the official NPI Registry.