NPIMap

Organization Active NPI

Stewart Memorial Community Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Lake City, IA
National Provider Identifier
1063598175
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
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
Oct 31, 2006
Last updated
Mar 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
STEWART MEMORIAL COMMUNITY HOSPITALAs reported in NPPES

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 130029H IA Primary
Critical Access Hospital 282NC0060X 130029H IA

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
0655258MedicaidIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070130000647 IA Part A Provider - Critical Access Hospital 4486563707 Practice locations: Lake City, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063598175. Details of each certification follow.

Hospital certification: CCN 16Z350

Legal name
STEWART MEMORIAL COMMUNITY HOSPITAL
Doing business as
STEWART MEMORIAL COMMUNITY HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
May 29, 1958 in IA
Enrollment address
1301 W Main St
Lake City, IA 51449-1585
Hospital Swing-Bed Unit

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).

National Provider Directory

National Provider Directory
Tax ID family
Stewart Mem Community5 organizations share this tax ID, including this one
Part of
Stewart Mem Community

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
Derek L Duncan Individual Corporate DirectorMedical Staff President Apr 1, 2024
W-2 Managing EmployeeMedical Staff President Apr 1, 2024
Operational/Managerial ControlMedical Staff President Apr 1, 2024

Owners & managing parties with NPI records 1

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

  • Derek L Duncan, DO
    • Family Medicine Physician
    • Lake City, IA
    • NPI 1487764957

    Corporate Director, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

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

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1063598175",
    "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": "YES",
        "parent_organization_legal_business_name": "STEWART MEMORIAL COMMUNITY HOSPITAL",
        "enumeration_date": "2006-10-31",
        "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": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "IA",
            "license": "130029H",
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IA",
            "license": "130029H",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0655258",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, IA

Sources for this page

Verify at the official NPI Registry.