NPIMap

Organization Active NPI

Hawarden Regional Healthcare Clinics LLC

Doing business as Hawarden Clinic

  • Rural Health Clinic/Center
  • Hawarden, IA
National Provider Identifier
1013955004
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HAWARDEN REGIONAL HEALTHCARE CLINICS LLC
Doing business as
Hawarden Clinic
Practice address
1122 12TH St
Hawarden, IA 51023-1900
Phone
(712) 551-3400
NPI assigned
Jun 3, 2006
Last updated
Sep 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

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

Authorized official

Name
Jayson P Pullman
Title
President
Phone
(712) 551-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

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 names 1

  • HAWARDEN CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013955004. Details of each certification follow.

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
LLCProprietary
Incorporated
Aug 3, 2004 in IA
Enrollment address
1122 12TH St
Hawarden, IA 51023-1900
Related CCNs
161311

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

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Hawarden Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Hawarden Regional Healthcare Organization, Hawarden, IA Non-profit 5% Or Greater Direct Ownership Interest Aug 3, 2004 50%
Operational/Managerial Control Aug 3, 2004
Kelsi a Brunsting Individual W-2 Managing EmployeeAd;Clinic Manager Apr 30, 2024
Operational/Managerial ControlClinic Manager Apr 30, 2024
Stanley Hoekstra Individual Corporate Director Jan 10, 2019
Mercy Medical Services Organization, Sioux City, IA Corporation, For-profit 5% Or Greater Direct Ownership Interest Aug 3, 2004 50%
Operational/Managerial Control Aug 3, 2004
Dale P Nystrom Individual Contracted Managing EmployeeMD; May 27, 2007
Operational/Managerial ControlMedical Director May 27, 2007
Dennis M Hulshof Individual Corporate Director Jan 9, 2020
Jayson P Pullman Individual Contracted Managing EmployeeCeo Oct 5, 2011
Corporate OfficerPresident Oct 5, 2011
Corporate DirectorPresident Oct 5, 2011
Operational/Managerial ControlCeo Oct 5, 2011
Brody P Hala Individual Corporate Director Apr 10, 2025
Barbara K Barnett Individual Corporate Director Jan 10, 2024

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Hawarden Regional Healthcare

    dba Akron Clinic

    • Rural Health Clinic/Center
    • Akron, IA
    • NPI 1487289955

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Hawarden Regional Healthcare
    • Medicare Defined Swing Bed Hospital Unit
    • Hawarden, IA
    • NPI 1790740884

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Hawarden Regional Healthcare
    • Critical Access Hospital
    • Hawarden, IA
    • NPI 1841261104

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Mercy Medical Services

    dba MercyOne Primghar Family Medicine

    • Rural Health Clinic/Center
    • Primghar, IA
    • NPI 1033948641

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Mercy Medical Services

    dba Anthon Mercy Medical Clinic

    • Rural Health Clinic/Center
    • Anthon, IA
    • NPI 1255379400

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Mercy Medical Services

    dba MercyOne Correctionville Family Medicine

    • Rural Health Clinic/Center
    • Correctionville, IA
    • NPI 1336187277

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Mercy Medical Services

    dba MercyOne Kingsley Family Medicine

    • Rural Health Clinic/Center
    • Kingsley, IA
    • NPI 1790723633

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Dale Nystrom, MD
    • Family Medicine Physician
    • Sioux Center, IA
    • NPI 1528128444

    Contracted Managing Employee, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758499200000",
    "number": "1013955004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 12TH ST",
            "city": "HAWARDEN",
            "state": "IA",
            "postal_code": "510231900",
            "telephone_number": "712-551-3400",
            "fax_number": "712-551-2691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 12TH ST",
            "city": "HAWARDEN",
            "state": "IA",
            "postal_code": "510231900",
            "telephone_number": "712-551-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAWARDEN REGIONAL HEALTHCARE CLINICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A",
        "authorized_official_last_name": "PULLMAN",
        "authorized_official_first_name": "JAYSON",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "712-551-3100"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HAWARDEN CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hawarden, IA

Sources for this page

Verify at the official NPI Registry.