Hawarden Regional Healthcare Clinics LLC
Organization Active NPI Rural Health Clinic/Center · Hawarden, IA
NPI 1013955004 · NPPES record last updated Sep 22, 2025
Key facts
- NPI
- 1013955004
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- HAWARDEN REGIONAL HEALTHCARE CLINICS LLC
- Practice address
- 1122 12TH St
Hawarden, IA 51023-1900 - Phone
- (712) 551-3400
- NPI assigned
- Jun 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Jayson P Pullman
- Title
- President
- Phone
- (712) 551-3100
Owners & managing parties with NPI records 8
-
Dale Nystrom, MD
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Member of 3
Related certifications (CCN) 1
Practitioners 36
-
Rodrigo Ernesto Banda, PA-C
-
Karen Sue Kennedy, ARNP
-
Dale Nystrom, MD
-
Molly M Post, ARNP
-
Cindi S Rule, ARNP
-
Alyssa Jane Sackett, FNP-C
-
Amy Waterman, CNP
-
Margot Duchowny, APRN
-
Berkley A Erickson, CNP
-
Justin Travis Goff, LCSW
-
Crystal Minor, FNP
-
Ashley Johnson, PA-C
-
Denise S Hanisch, MD
-
Anne Grady Healy, MD
-
Zachary Chris Lippert, APRN
-
Paul R. Niles, PA-C
-
Kelly Scott Pomerenke, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA
Rural health clinic certification: CCN 168503
- Legal name
- HAWARDEN REGIONAL HEALTHCARE CLINICS LLC
- Doing business as
- HAWARDEN CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- May 27, 2007
- Last certification
- Sep 15, 2021
- Ownership / control type
- Non-profit – church related
- Organization structure
- LLC · Proprietary
- Incorporated
- Aug 3, 2004 in IA
- Enrollment address
- 1122 12TH St
Hawarden, IA 51023-1900 - Related CCNs
- 161311
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Hawarden Regional Healthcare |
5% Or Greater Direct Ownership Interest | Aug 3, 2004 | 50% |
| Operational/Managerial Control | Aug 3, 2004 | ||
| Kelsi a Brunsting |
W-2 Managing Employee |
Apr 30, 2024 | |
| Operational/Managerial Control |
Apr 30, 2024 | ||
| Stanley Hoekstra |
Corporate Director | Jan 10, 2019 | |
| Mercy Medical Services |
5% Or Greater Direct Ownership Interest | Aug 3, 2004 | 50% |
| Operational/Managerial Control | Aug 3, 2004 | ||
| Dale P Nystrom |
Contracted Managing Employee |
May 27, 2007 | |
| Operational/Managerial Control |
May 27, 2007 | ||
| Dennis M Hulshof |
Corporate Director | Jan 9, 2020 | |
| Jayson P Pullman |
Contracted Managing Employee |
Oct 5, 2011 | |
| Corporate Officer |
Oct 5, 2011 | ||
| Corporate Director |
Oct 5, 2011 | ||
| Operational/Managerial Control |
Oct 5, 2011 | ||
| Brody P Hala |
Corporate Director | Apr 10, 2025 | |
| Barbara K Barnett |
Corporate Director | Jan 10, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041102000519 | IA | Part a Provider - Rural Health Clinic | 7517929532 | Practice locations: Hawarden, IA |
| O20050411000652 | IA | Part B Supplier - Clinic/Group Practice | 7517929532 |
Receives reassigned benefits from 37 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Hawarden, IA; Ireton, IA |
National Provider Directory
- Tax ID family
- Hawarden Clinic
Locations
1122 12th St
Hawarden, IA 51023
Phone (712) 551-3400
1122 Avenue L
Hawarden, IA 51023
Phone (712) 551-3400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1122 12TH St
Hawarden, IA 51023-1900
Mailing address
1122 12TH St
Hawarden, IA 51023-1900
Phone (712) 551-3400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0685032 | Medicaid | IA |
Other names
- HAWARDEN CLINIC
Other providers in Hawarden, IA
- Hawarden Family Chiropractic Inc
- Hawarden Family Eye Care PLLC
- Hawarden Regional Healthcare
- Hawarden Regional Healthcare
- Hawarden Regional Healthcare
- Hawarden Regional Healthcare Clinics LLC
- Matt Hummel
- Kathleen D Keltz
- Kathleen D Keltz
- Karen Sue Kennedy
All providers in Hawarden, IA · Rural Health Clinic/Center in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.