NPIMap

Organization Active NPI

Mercy Medical Services

Doing business as MercyOne Primghar Family Medicine

  • Rural Health Clinic/Center
  • Primghar, IA
National Provider Identifier
1033948641
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY MEDICAL SERVICES
Doing business as
MercyOne Primghar Family Medicine
Practice address
240 N Rerick Ave
Primghar, IA 51245-7786
Phone
(712) 957-2310
Fax
(712) 957-0504
NPI assigned
Jul 31, 2024
Last updated
Nov 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Authorized official

Name
Jesica Hanson
Title
VP Finance
Phone
(712) 279-5850

Specialties & licenses 1

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

Addresses

Primary practice location

240 N Rerick Ave
Primghar, IA 51245-7786

Mailing address

600 1St St NW Ste 101
Mason City, IA 50401-2932

Other names 1

  • MercyOne Primghar Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241017002365 IA Part A Provider - Rural Health Clinic 5799694063 Practice locations: Primghar, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033948641. Details of each certification follow.

Rural health clinic certification: CCN 168987

Legal name
MERCY MEDICAL SERVICES
Doing business as
MERCYONE PRIMGHAR FAMILY MEDICINE
Organization structure
CorporationNon-profit
Incorporated
Sep 23, 1986 in IA
Enrollment address
240 N Rerick Ave
Primghar, IA 51245-7786

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory

Member of 1

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

Member organizations 6

Organizations listed as members of this organization in the National Provider Directory.

Locations

212 E Bow Dr
Cherokee, IA 51012
Phone (712) 225-6431

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

1125 Pierce St
Sioux City, IA 51105
Phone (712) 255-8901

2928 Hamilton Blvd
Lowr 1E
Sioux City, IA 51104
Phone (712) 202-0777

3500 Singing Hills Blvd
Ste 100
Sioux City, IA 51106
Phone (712) 274-4250

801 5th St
Ste 5428
Sioux City, IA 51101
Phone (712) 279-2950

804 5TH St
Sioux City, IA 51101
Phone (712) 279-2010

1427 W Milwaukee Ave
Storm Lake, IA 50588
Phone (712) 372-9600

702 Cedar Ave
Laurel, NE 68745
Phone (402) 256-2961

212 Vly VW Dr
Pender, NE 68047
Phone (402) 385-3072

330 Dakota Dunes Blvd
Ste 200
Dakota Dunes, SD 57049
Phone (605) 232-6200

612 N Sioux Point Rd
Ste 500
Dakota Dunes, SD 57049
Phone (605) 232-6200

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Maurita Soukup Individual Corporate DirectorBoard Member Jan 1, 2017
Tracy R Larson Individual W-2 Managing EmployeeVP Patient Services/Cno Jul 9, 2001
Linda Ross Individual Corporate DirectorBoard Member Jan 1, 2020
Robert P Ritz Individual Corporate OfficerPresident & Ceo Jan 1, 2018
Corporate DirectorBoard Member Jan 1, 2018
Thomas Clark Individual Corporate OfficerPresident Feb 27, 2023
Operational/Managerial ControlPresident Feb 27, 2023
Heather Campbell Individual Corporate OfficerSecretary Jan 1, 2020
Mercy Health Network Inc Organization, Clive, IA Corporation, Non-profit Operational/Managerial Control Mar 1, 2016 100%
Jesica Hanson Individual Corporate OfficerAssistant Treasurer Aug 13, 2019
Operational/Managerial ControlAssistant Treasurer Aug 13, 2019
Mercy Health Services-Iowa Corp Organization, Mason City, IA Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 19, 1998 100%
Trinity Health Corporation Organization, Livonia, MI Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest May 1, 2000 100%
Stuart Kilpinen Individual Operational/Managerial ControlChain Home Office Administrator Jun 10, 2023
Terri Donovan Individual Corporate OfficerTreasurer Jan 1, 2024
Lucille Heid Individual Corporate OfficerChair Jan 1, 2017
Corporate DirectorBoard Member Jan 1, 2017

Owners & managing parties with NPI records 11

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hawarden ClinicHawarden, IA, CCN 168503 Rural health clinic 5% Or Greater Direct Ownership Interest (50%)
Operational/Managerial Control		 Aug 3, 2004
Aug 3, 2004

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 215

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 215

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1722384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1033948641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 1ST ST NW STE 101",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504012932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 N RERICK AVE",
            "city": "PRIMGHAR",
            "state": "IA",
            "postal_code": "512457786",
            "telephone_number": "712-957-2310",
            "fax_number": "712-957-0504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-31",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "JESICA",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "712-279-5850"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MercyOne Primghar Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MercyOne Primghar Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Primghar, IA

Sources for this page

Verify at the official NPI Registry.