NPIMap

Organization Active NPI

Clarke County Public Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Osceola, IA
National Provider Identifier
1073555462
Registry record updated Feb 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
200012H Issued in IA
Legal business name
CLARKE COUNTY PUBLIC HOSPITAL
Practice address
800 S Fillmore St
Osceola, IA 50213-1694
Phone
(641) 342-2184
Fax
(641) 342-5318
NPI assigned
Jun 12, 2006
Last updated
Feb 3, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
CLARKE COUNTY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 3, 2025

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

Authorized official

Name
Mrs. Susan Daniels
Title
Cfo
Phone
(641) 342-2184

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 200012H IA Primary
Critical Access Hospital 282NC0060X 200012H IA

Addresses

Primary practice location

800 S Fillmore St
Osceola, IA 50213-1694

Mailing address

800 S Fillmore St
Osceola, IA 50213-1694
Phone (641) 342-2184

Other identifiers 2

IdentifierTypeStateIssuer
66049OtherWELLMARK SWINGBED #
0655209MedicaidIA

Other names 1

  • Clarke County Hospital Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070109000600 IA Part A Provider - Critical Access Hospital 1951219328 Practice locations: Osceola, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073555462. Details of each certification follow.

Hospital certification: CCN 16Z348

Legal name
CLARKE COUNTY PUBLIC HOSPITAL
Doing business as
CLARKE COUNTY HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
800 S Fillmore St
Osceola, IA 50213-1694
Hospital Swing-Bed Unit

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

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
Tax ID family
Wolfe Pet5 organizations share this tax ID, including this one
Part of
Wolfe Pet

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 13

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

NameRoleSinceShare
Teresa L Woods Individual Corporate Officer Jan 26, 2011
Corporate Director Jan 1, 2007
Amy S Lampe Individual Corporate Director Feb 26, 2020
Tessa M Sandel Individual Corporate OfficerCno Feb 1, 2025
W-2 Managing EmployeeCno Feb 1, 2025
Operational/Managerial ControlCno Feb 1, 2025
Central Iowa Hospital Corporation Organization, Des Moines, IA Corporation, Non-profit Operational/Managerial Control Dec 1, 1987
Kelly C Blanchard Individual Corporate Director Oct 28, 2015
Kevin W Klemesrud Individual Corporate Officer Jan 1, 2015
Corporate Director Feb 24, 2011
Elizabeth Herrera Individual Corporate Director Jan 29, 2025
Terry J Jacobsen Individual Corporate Director Apr 1, 2015
Susan Daniels Individual Corporate OfficerCfo Nov 11, 2024
W-2 Managing EmployeeCfo Nov 11, 2024
Operational/Managerial ControlCfo Nov 11, 2024
Deborah Kay Lundquist Individual Corporate Officer Jan 23, 2019
Corporate Director Jul 27, 2016
Melanie Boyd Individual Contracted Managing EmployeeCeo Jul 1, 2020
Corporate OfficerCeo Jul 24, 2024
Operational/Managerial ControlCeo Jul 1, 2020
George N Fotiadis Individual Operational/Managerial ControlChief of Staff Jan 18, 2006
Angela L McIntosh Individual Corporate OfficerCoo Jul 24, 2024
W-2 Managing EmployeeCoo Dec 31, 2024
Operational/Managerial ControlCoo Mar 14, 2022

Owners & managing parties with NPI records 8

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

Facilities with the same owner 22

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

View all 22

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": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738540800000",
    "number": "1073555462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S FILLMORE ST",
            "city": "OSCEOLA",
            "state": "IA",
            "postal_code": "502131694",
            "telephone_number": "641-342-2184",
            "fax_number": "641-342-5318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 S FILLMORE ST",
            "city": "OSCEOLA",
            "state": "IA",
            "postal_code": "502131694",
            "telephone_number": "641-342-2184",
            "fax_number": "641-342-5318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKE COUNTY PUBLIC HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLARKE COUNTY HOSPITAL",
        "enumeration_date": "2006-06-12",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "641-342-2184",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "IA",
            "license": "200012H",
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IA",
            "license": "200012H",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK SWINGBED #",
            "identifier": "66049",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0655209",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clarke County Hospital",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Osceola, IA

Sources for this page

Verify at the official NPI Registry.