NPIMap

Organization Active NPI

Story County Hospital

Doing business as Nevada Medical Clinic

  • Family Medicine Physician
  • Nevada, IA
National Provider Identifier
1023080504
Registry record updated Feb 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
STORY COUNTY HOSPITAL
Doing business as
Nevada Medical Clinic
Practice address
640 S 19TH St
Nevada, IA 50201-2902
Phone
(515) 382-5413
Fax
(515) 382-7107
NPI assigned
Feb 7, 2006
Last updated
Feb 10, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2017

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

Authorized official

Name
Mrs. Kemberlee S Packer
Title
Credentialing Specialist
Phone
(515) 382-7101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

640 S 19TH St
Nevada, IA 50201-2902

Mailing address

640 S 19TH St
Nevada, IA 50201-2902
Phone (515) 382-5413

Other names 1

  • Nevada Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040204000957 IA Part B Supplier - Clinic/Group Practice 0547153884 Receives reassigned benefits from 39 practitioners
5 other NPIs on this enrollment
Practice locations: Nevada, IA

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Locations

519 F Ave
Nevada, IA 50201
Phone (515) 382-5413

640 S 19th St
Nevada, IA 50201
Phone (515) 382-2111

640 S 19th St
Ste 100
Nevada, IA 50201
Phone (515) 382-5413

Practitioners & affiliated clinicians

Practitioners 39

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 39

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486684800000",
    "number": "1023080504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 S 19TH ST",
            "city": "NEVADA",
            "state": "IA",
            "postal_code": "502012902",
            "telephone_number": "515-382-5413",
            "fax_number": "515-382-7107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 S 19TH ST",
            "city": "NEVADA",
            "state": "IA",
            "postal_code": "502012902",
            "telephone_number": "515-382-5413",
            "fax_number": "515-382-7107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STORY COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2017-02-10",
        "status": "A",
        "authorized_official_last_name": "PACKER",
        "authorized_official_first_name": "KEMBERLEE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "515-382-7101",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nevada Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nevada, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2017; 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.