NPIMap

Organization Active NPI

River Hills Community Health Center Inc.

Doing business as RHCHC-Wapello County Behavioral Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Ottumwa, IA
National Provider Identifier
1083380059
Registry record updated Aug 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RIVER HILLS COMMUNITY HEALTH CENTER INC.
Doing business as
RHCHC-Wapello County Behavioral Health Clinic
Practice address
216 S Market St
Ottumwa, IA 52501-2923
Phone
(641) 683-5773
Fax
(641) 226-5759
NPI assigned
Aug 19, 2021
Last updated
Aug 19, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2021

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

Authorized official

Name
Kim Grove
Title
Revenue Cycle Director
Phone
(641) 684-6896

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

216 S Market St
Ottumwa, IA 52501-2923

Mailing address

PO Box 458
Ottumwa, IA 52501-0458
Phone (641) 684-6896

Other names 1

  • RHCHC-Wapello County Behavioral Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210901001891 IA Part A Provider - Federally Qualified Health Center (FQHC) 8426076225 Practice locations: Ottumwa, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083380059. Details of each certification follow.

Federally qualified health center certification: CCN 161001

Legal name
RIVER HILLS COMMUNITY HEALTH CENTER INC
Doing business as
RHCHC-WAPELLO COUNTY BEHAVIORAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 6, 2021
Last certification
Oct 6, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
216 S Market St
Ottumwa, IA 52501-2923

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
River Hills Community Health Center Inc21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

1015 N 18th St
Ste C
Centerville, IA 52544
Phone (641) 856-4400

4045 Ashland Rd
Eldon, IA 52554
Phone (641) 652-7531

1000 S 6th St
Fairfield, IA 52556
Phone 64168357731303

404 W Fillmore Ave
Fairfield, IA 52556
Phone 64168357731303

406 E Madison Ave
Fairfield, IA 52556

100 W Main St
Richland, IA 52585
Phone (319) 456-2045

300 W Kelley St
Sigourney, IA 52591
Phone (641) 224-8061

907 E Pleasant Valley St
Sigourney, IA 52591
Phone (641) 684-6896

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
David Demerritt Individual Corporate Officer Aug 1, 2021
Mariamma T Mukkada Individual Corporate Officer Feb 1, 2010
Shea Greiner Individual Corporate Officer Mar 1, 2018
Thomas Shafer Individual Corporate Officer Sep 3, 2019
Rachelle Mitchell-Shadduck Individual Corporate Officer Mar 1, 2018
Joshua Stevens Individual Corporate Officer Sep 3, 2019
Jacquelyn F Pope Individual Corporate Officer Jul 1, 2012
Kimberly Grove Individual Corporate DirectorRevenue Cycle Director Oct 13, 2004
W-2 Managing Employee Oct 13, 2004
Brenda Hostetler Individual Corporate Officer Mar 1, 2018
Gina M Throckmorton Individual Corporate Director Oct 13, 2003
Diana Hughell Individual Corporate Officer Sep 3, 2019
Michelle H Swanstrom Individual Corporate Officer Feb 1, 2010
Richard Johnson Individual Corporate DirectorCeo Jun 16, 2005

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629331200000",
    "number": "1083380059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 458",
            "city": "OTTUMWA",
            "state": "IA",
            "postal_code": "525010458",
            "telephone_number": "641-684-6896",
            "fax_number": "641-226-5759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 S MARKET ST",
            "city": "OTTUMWA",
            "state": "IA",
            "postal_code": "525012923",
            "telephone_number": "641-683-5773",
            "fax_number": "641-226-5759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER HILLS COMMUNITY HEALTH CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-19",
        "last_updated": "2021-08-19",
        "certification_date": "2021-07-29",
        "status": "A",
        "authorized_official_last_name": "GROVE",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "641-684-6896"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RHCHC-Wapello County Behavioral Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ottumwa, IA

Sources for this page

Verify at the official NPI Registry.