NPIMap

Organization Active NPI

Alegent Health Community Memorial Hospital of Missouri Valley, Iowa

Doing business as CHI Health Clinic Woodbine

  • Rural Health Clinic/Center
  • Woodbine, IA
National Provider Identifier
1073694774
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA
Doing business as
CHI Health Clinic Woodbine
Practice address
518 Lincolnway St
Woodbine, IA 51579-1238
Phone
(712) 647-2566
Fax
(712) 647-2964
NPI assigned
Oct 18, 2006
Last updated
Jan 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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

Authorized official

Name
Evert Kuiper
Title
Ceo - CHI Health
Phone
(402) 343-4420

Specialties & licenses 1

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

Addresses

Primary practice location

518 Lincolnway St
Woodbine, IA 51579-1238

Mailing address

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

Other names 1

  • CHI Health Clinic Woodbine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

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
This NPI is an additional NPI on the enrollment
Practice locations: Missouri Valley, IA; Woodbine, IA; Oakland, IA; Logan, IA; Dunlap, IA
O20070531000454 IA Part A Provider - Rural Health Clinic 3678482130 Practice locations: Woodbine, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073694774. Details of each certification follow.

Rural health clinic certification: CCN 163477

Legal name
ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IOWA
Doing business as
CHI HEALTH CLINIC WOODBINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 23, 1999
Last certification
Feb 15, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 22, 1955 in IA
Enrollment address
518 Lincolnway St
Woodbine, IA 51579-1238
Related CCNs
161309

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

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
Tax ID family
Alegent Health8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
CHI Nebraska Organization, Omaha, NE Corporation 5% Or Greater Direct Ownership Interest Aug 1, 2013 100%
Marvin O'Quinn Individual OtherCSH Home Office Administrator Aug 1, 2022
Nadine a Heimann Individual Corporate Director Jul 1, 2019
Maurita Soukup Individual Corporate Director Jul 1, 2017
Commonspirit Health Organization, Englewood, CO Non-profit 5% Or Greater Indirect Ownership Interest Aug 1, 2013 100%
David Jones Individual Operational/Managerial ControlPresident Apr 17, 2021
William Barney Individual Corporate Director Jul 1, 2020
Kevin Fitzgerald Individual Corporate DirectorBod Jul 15, 2021
Suzanne L Hruza Individual Corporate DirectorBoard Member Sep 18, 2014
Nick O'Tool Individual Operational/Managerial ControlInterim Cfo - CHI Health Jan 7, 2023
Heather M Morgan Individual Corporate Director Jul 1, 2020
Kirtibala Gupta Individual Corporate DirectorBod Jul 15, 2021
Evert Kuiper Individual Corporate DirectorCeo - CHI Health Jan 17, 2022
Operational/Managerial ControlCeo - CHI Health Jan 17, 2022
John E Petersdorf Individual Corporate Director Jan 21, 2021
William Yates Individual Corporate Director Oct 1, 2015
Mardell Wilson Individual Corporate Director Oct 15, 2020
Kelly Bacon Individual Corporate DirectorBod Jul 15, 2021

Owners & managing parties with NPI records 3

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

Facilities with the same owner 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1073694774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 LINCOLNWAY ST",
            "city": "WOODBINE",
            "state": "IA",
            "postal_code": "515791238",
            "telephone_number": "712-647-2566",
            "fax_number": "712-647-2964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 LINCOLNWAY ST",
            "city": "WOODBINE",
            "state": "IA",
            "postal_code": "515791238",
            "telephone_number": "712-647-2566",
            "fax_number": "712-647-2964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "KUIPER",
        "authorized_official_first_name": "EVERT",
        "authorized_official_title_or_position": "CEO - CHI HEALTH",
        "authorized_official_telephone_number": "402-343-4420"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI Health Clinic Woodbine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHI Health Clinic Woodbine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodbine, IA

Sources for this page

Verify at the official NPI Registry.