NPIMap

Organization Active NPI

Sioux Valley Memorial Hospital Association

Doing business as Cherokee Regional Clinic - Aurelia

  • Family Medicine Physician
  • Aurelia, IA
National Provider Identifier
1083610190
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION
Doing business as
Cherokee Regional Clinic - Aurelia
Practice address
225 Main St
Aurelia, IA 51005-7791
Phone
(712) 434-2101
Fax
(712) 434-5550
NPI assigned
Jun 23, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Joan M Bierman
Title
Cfo
Phone
(712) 225-3368

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X IA Primary
Rural Health Clinic/Center 261QR1300X NU

Addresses

Primary practice location

225 Main St
Aurelia, IA 51005-7791

Mailing address

300 Sioux Valley Dr
Cherokee, IA 51012-1205
Phone (712) 225-6265

Other identifiers 1

IdentifierTypeStateIssuer
0105742MedicaidIA

Other names 1

  • Cherokee Regional Clinic - Aurelia Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040317001463 IA Part B Supplier - Clinic/Group Practice 4880501881 Receives reassigned benefits from 36 practitioners
3 other NPIs on this enrollment
Practice locations: Aurelia, IA; Cherokee, IA; Marcus, IA
O20190703001201 IA Part A Provider - Rural Health Clinic 4880501881 Practice locations: Aurelia, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083610190. Details of each certification follow.

Rural health clinic certification: CCN 168623

Legal name
SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION
Doing business as
AURELIA MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 22, 2019
Last certification
Sep 20, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 17, 1916 in IA
Enrollment address
225 Main St
Aurelia, IA 51005-7791
Related CCNs
161362

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

Other NPIs with the same Medicare PAC ID 9

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
16D0857186Aurelia Medical Clinic225 Main Street, Aurelia, IA 51005Provider-performed microscopySep 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Sioux Valley Medical9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

300 Sioux Valley Dr
Cherokee, IA 51012
Phone (712) 225-3368

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Tyler Gerstandt Individual Corporate OfficerCfo Apr 7, 2023
Kellen Ludvigson Individual Corporate Director Apr 12, 2021
Clay Leavitt Individual Corporate DirectorBoard of Directors Apr 13, 2020
St. Luke's Health System, Inc. Organization, Sioux City, IA Non-profit Operational/Managerial Control Oct 1, 2013
Leslie William Todd Individual Corporate DirectorBoard Member Jan 1, 2019
Sheila Trapp Individual Corporate DirectorBoard Member Jan 1, 2019
Kerry Marie Hurd Individual Corporate Director Apr 12, 2022
Sarah Cook Individual Corporate DirectorBoard Member Jan 1, 2019
Gary W Jordan Individual Contracted Managing EmployeeCeo Jan 1, 2019
Brandon Henke Individual Corporate Director Apr 12, 2021

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Heartland Care Center IncMarcus, IA, CCN 165397 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Jul 19, 2023
Jul 19, 2023
Jul 19, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 11

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

Practitioners & affiliated clinicians

Practitioners 66

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 66

NPI Registry JSON

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1083610190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SIOUX VALLEY DR",
            "city": "CHEROKEE",
            "state": "IA",
            "postal_code": "510121205",
            "telephone_number": "712-225-6265",
            "fax_number": "712-225-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 MAIN ST",
            "city": "AURELIA",
            "state": "IA",
            "postal_code": "510057791",
            "telephone_number": "712-434-2101",
            "fax_number": "712-434-5550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BIERMAN",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "712-225-3368"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0105742",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cherokee Regional Clinic - Aurelia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cherokee Regional Clinic - Aurelia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aurelia, IA

Sources for this page

Verify at the official NPI Registry.