NPIMap

Organization Active NPI

Keokuk County Health Center

  • Rural Health Clinic/Center
  • Sigourney, IA
National Provider Identifier
1073898649
Registry record updated Oct 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
KEOKUK COUNTY HEALTH CENTER
Practice address
23019 Highway 149
Sigourney, IA 52591-8341
Phone
(641) 622-2720
Fax
(641) 622-1187
NPI assigned
Oct 14, 2011
Last updated
Oct 9, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
KEOKUK COUNTY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 9, 2019

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

Authorized official

Name
Matt Ives
Title
Cfo
Phone
(641) 622-2720

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 540100H IA
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

23019 Highway 149
Sigourney, IA 52591-8341

Mailing address

23019 Highway 149
Sigourney, IA 52591-8341
Phone (641) 622-2720

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031222000672 IA Part B Supplier - Clinic/Group Practice 0244138774 Receives reassigned benefits from 53 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hedrick, IA; Sigourney, IA
O20160211000911 IA Part A Provider - Rural Health Clinic 0244138774 Practice locations: Sigourney, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073898649. Details of each certification follow.

Rural health clinic certification: CCN 168585

Legal name
KEOKUK COUNTY HEALTH CENTER
Doing business as
KEOKUK COUNTY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 12, 2016
Last certification
Sep 12, 2016
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
1314 S Stuart Street
Suite B
Sigourney, IA 52591-1154
Related CCNs
161315

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2094213Keokuk County Medical Clinic1314 S Stuart Street, Suite B, Sigourney, IA 52591Certificate of waiverApr 12, 2027

National Provider Directory

National Provider Directory
Part of
Keokuk Co Ambserv

Locations

1314 S Stuart St
Ste B
Sigourney, IA 52591
Phone (641) 622-1148

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/keocohc-1efc0458

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Rebecca Klett Individual W-2 Managing EmployeeClinic Nurse Supervisor Jun 1, 2016
Anna K Clark Individual W-2 Managing EmployeeClinic Manager Jun 1, 2016
Wendy M Stuhr Individual W-2 Managing EmployeeDirector of Nurses Jun 1, 2016
Matthew J Ives Individual Corporate OfficerAdministrator/Cfo Jun 1, 2016
W-2 Managing EmployeeAdministrator/Cfo Jun 1, 2016
Casey C Thompson Individual W-2 Managing EmployeeDirector of Ancillary Services/P Jun 1, 2016

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1318550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570579200000",
    "number": "1073898649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23019 HIGHWAY 149",
            "city": "SIGOURNEY",
            "state": "IA",
            "postal_code": "525918341",
            "telephone_number": "641-622-2720",
            "fax_number": "641-622-1187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23019 HIGHWAY 149",
            "city": "SIGOURNEY",
            "state": "IA",
            "postal_code": "525918341",
            "telephone_number": "641-622-2720",
            "fax_number": "641-622-1187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEOKUK COUNTY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KEOKUK COUNTY HEALTH CENTER",
        "enumeration_date": "2011-10-14",
        "last_updated": "2019-10-09",
        "status": "A",
        "authorized_official_last_name": "IVES",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "641-622-2720"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IA",
            "license": "540100H",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sigourney, IA

Sources for this page

Verify at the official NPI Registry.