NPIMap

Organization Active NPI

Stewart Memorial Community Hospital

  • Critical Access Hospital
  • Lake City, IA
National Provider Identifier
1063497188
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
130029H Issued in IA
Legal business name
STEWART MEMORIAL COMMUNITY HOSPITAL
Practice address
1301 W Main St
Lake City, IA 51449-1585
Phone
(712) 464-3171
Fax
(712) 464-3269
NPI assigned
Dec 12, 2005
Last updated
Mar 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Authorized official

Name
Mr. James L. Henkenius
Title
Cfo
Phone
(712) 464-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 130029H IA Primary

Addresses

Primary practice location

1301 W Main St
Lake City, IA 51449-1585

Mailing address

1301 W Main St
Lake City, IA 51449-1585
Phone (712) 464-3171

Other identifiers 1

IdentifierTypeStateIssuer
0600726MedicaidIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061104000122 IA Part A Provider - Critical Access Hospital 4486563707 Receives reassigned benefits from 22 practitioners
Practice locations: Lake City, IA; Rockwell City, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063497188. Details of each certification follow.

Hospital certification: CCN 161350

Legal name
STEWART MEMORIAL COMMUNITY HOSPITAL
Doing business as
STEWART MEMORIAL COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2003
Last certification
Sep 23, 2021
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
May 29, 1958 in IA
Enrollment address
1301 W Main St
Lake City, IA 51449-1585
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 5

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Stewart Memorial Community HospitalCCN 161350 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Stewart Memorial Conmmu5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Ann Lynn Lengeling Individual W-2 Managing EmployeeCno Aug 4, 2020
Operational/Managerial ControlCno Aug 4, 2020
James L Henkenius Individual Corporate OfficerCfo Nov 26, 2013
W-2 Managing EmployeeCfo Sep 1, 1997
Operational/Managerial ControlCfo Sep 1, 1997
Trinity Health Systems, Inc Organization, Fort Dodge, IA Corporation, Non-profit Operational/Managerial Control Aug 1, 2012
Jennifer L Lane Individual Corporate Director Apr 26, 2022
Theresa J Hildreth Individual Corporate Officer Apr 23, 2019
Corporate Director May 24, 2016
Stacy D Corey Individual Corporate Officer Apr 1, 2024
Corporate Director Apr 26, 2022
Charles E Schmitt Individual Corporate Director Oct 24, 2023
Scott a Nesbitt Individual Corporate Officer Apr 1, 2023
Corporate Director Apr 1, 2012
Jordan a Lietz Individual Corporate Officer Apr 26, 2022
Corporate Director Apr 28, 2018
Mary M Lauver Individual Corporate Director Apr 26, 2022
Linn Block Individual Contracted Managing EmployeeCeo Dec 11, 2023
Corporate OfficerCeo Dec 11, 2023
Operational/Managerial ControlCeo Dec 11, 2023
Julia a Richardson Individual Corporate DirectorMedical Staff President Jan 21, 2026
W-2 Managing EmployeeMedical Staff President Jan 21, 2026
Operational/Managerial ControlMedical Staff President Jan 21, 2026

Owners & managing parties with NPI records 1

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

Facilities with the same owner 27

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

View all 27

Practitioners & affiliated clinicians

Practitioners 22

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 22

Affiliated clinicians 89

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 89

NPI Registry JSON

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

{
    "created_epoch": "1134345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1063497188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 W MAIN ST",
            "city": "LAKE CITY",
            "state": "IA",
            "postal_code": "514491585",
            "telephone_number": "712-464-3171",
            "fax_number": "712-464-3269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 W MAIN ST",
            "city": "LAKE CITY",
            "state": "IA",
            "postal_code": "514491585",
            "telephone_number": "712-464-3171",
            "fax_number": "712-464-3269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEWART MEMORIAL COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-12",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "HENKENIUS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "712-464-4200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IA",
            "license": "130029H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0600726",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, IA

Sources for this page

Verify at the official NPI Registry.