NPIMap

Organization Active NPI

Alegent Health Community Memorial Hospital of Missouri Valley Iowa

Doing business as CHI Health Missouri Valley

  • Family Medicine Physician
  • Missouri Valley, IA
National Provider Identifier
1023154176
Registry record updated Jan 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IOWA
Doing business as
CHI Health Missouri Valley
CHI Health Clinic
Practice address
809 E Elm Street
Missouri Valley, IA 51555-1140
Phone
(712) 642-2794
Fax
(402) 642-9338
NPI assigned
Jan 29, 2007
Last updated
Jan 27, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CHI HEALTH NEBRASKAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 27, 2020

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

Authorized official

Name
Keith Jankuski
Title
Coo
Phone
(402) 343-4409

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

809 E Elm Street
Missouri Valley, IA 51555-1140

Mailing address

7261 Mercy Rd
Omaha, NE 68124-2311
Phone (402) 398-6255

Other practice location 1

518 Lincolnway St
Woodbine, IA 51579-1238
Phone (712) 647-2566

Other practice location 2

118 S 1st Ave
Logan, IA 51546-1306
Phone (712) 644-3288

Other practice location 3

704 Iowa Ave
Dunlap, IA 51529-1336
Phone (712) 643-2298

Other names 2

  • CHI HEALTH MISSOURI VALLEY Doing business as
  • CHI Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040129001183 IA Part B Supplier - Clinic/Group Practice 3678482130 Receives reassigned benefits from 49 practitioners
2 other NPIs on this enrollment
Practice locations: Missouri Valley, IA; Woodbine, IA; Oakland, IA; Logan, IA; Dunlap, IA

Other NPIs with the same Medicare PAC ID 7

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

Member of 6

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

Locations

518 Lincolnway St
Woodbine, IA 51579
Phone (712) 647-2566

Practitioners & affiliated clinicians

Practitioners 50

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 50

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580083200000",
    "number": "1023154176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7261 MERCY RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242311",
            "telephone_number": "402-398-6255",
            "fax_number": "402-829-8513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 E ELM STREET",
            "city": "MISSOURI VALLEY",
            "state": "IA",
            "postal_code": "515551140",
            "telephone_number": "712-642-2794",
            "fax_number": "402-642-9338"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "518 Lincolnway St",
            "address_purpose": "LOCATION",
            "city": "Woodbine",
            "state": "IA",
            "postal_code": "515791238",
            "country_code": "US",
            "telephone_number": "712-647-2566",
            "fax_number": "712-647-2964",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "118 S 1st Ave",
            "address_purpose": "LOCATION",
            "city": "Logan",
            "state": "IA",
            "postal_code": "515461306",
            "country_code": "US",
            "telephone_number": "712-644-3288",
            "fax_number": "712-644-2964",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "704 Iowa Ave",
            "address_purpose": "LOCATION",
            "city": "Dunlap",
            "state": "IA",
            "postal_code": "515291336",
            "country_code": "US",
            "telephone_number": "712-643-2298",
            "fax_number": "712-643-5630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IOWA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHI  HEALTH NEBRASKA",
        "enumeration_date": "2007-01-29",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A",
        "authorized_official_last_name": "JANKUSKI",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "402-343-4409"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI HEALTH MISSOURI VALLEY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHI Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHI Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Missouri Valley, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2020; 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.