NPIMap

Organization Active NPI

Palmer Lutheran Health Center, Inc.

Doing business as Gundersen Palmer Lutheran Hospital and Clinics - Hospice

  • Community Based Hospice Care Agency
  • West Union, IA
National Provider Identifier
1083663397
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
330070H Issued in IA
Legal business name
PALMER LUTHERAN HEALTH CENTER, INC.
Doing business as
Gundersen Palmer Lutheran Hospital and Clinics - Hospice
Practice address
200 Jefferson St
West Union, IA 52175-1024
Phone
(563) 422-6267
Fax
(563) 422-9876
NPI assigned
May 6, 2006
Last updated
Aug 3, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
GUNDERSEN LUTHERAN HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

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

Authorized official

Name
Patrice Kuennen
Title
Ceo
Phone
(563) 422-3811

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 330070H IA Primary

Addresses

Primary practice location

200 Jefferson St
West Union, IA 52175-1024

Mailing address

200 Jefferson St
West Union, IA 52175-1024
Phone (563) 422-6267

Other practice location 1

230 2nd Ave SE
Oelwein, IA 50662-2417
Phone (319) 283-4489

Other names 1

  • Gundersen Palmer Lutheran Hospital and Clinics - Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040303000980 IA Part A Provider - Hospice 4284544255 Practice locations: Oelwein, IA; West Union, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083663397. Details of each certification follow.

Hospice certification: CCN 161521

Legal name
PALMER LUTHERAN HEALTH CENTER INC
Doing business as
GUNDERSEN PALMER LUTHERAN HOSPITAL AND CLINICS - HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 19, 1992
Last certification
May 5, 2021
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Enrollment address
200 Jefferson St
West Union, IA 52175-1024

Other NPIs with the same Medicare PAC ID 9

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Gundersen Palmer Lutheran Hosp and Clinics-HospiceCCN 161521 · All quality measures
Ownership
Non-Profit
Certified
Mar 19, 1992
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Palmer Lutheran Health Center Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

120 2nd Ave SE
Waukon, IA 52172
Phone (563) 568-3000

200 Jefferson St
West Union, IA 52175
Phone (563) 422-6267

1207 Mulberry Ln
La Crosse, WI 54603
Phone (608) 775-0950

407 S Main St
Ste 103
Viroqua, WI 54665

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Rachel Kathryn Albrecht Individual Corporate Director Jan 1, 2023
Kristi M Flack Individual Corporate DirectorDirector Jan 24, 2018
Thomas Tornstrom Individual Corporate Director Jan 1, 2023
Nicole Havenstrite Individual Corporate DirectorBoard Member Jan 1, 2024
Patrice R Kuennen Individual Corporate OfficerCeo Oct 8, 2018
W-2 Managing EmployeeCeo Oct 8, 2018
Brenda S Moser Individual Corporate OfficerFinance Administrator Jan 1, 2025
Bellin Gundersen Health System Inc Organization, La Crosse, WI Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Nov 30, 2022 100%
Operational/Managerial Control Nov 30, 2022 100%
Jodi Webb Individual Corporate DirectorBoard Member Jan 1, 2025
Gundersen Lutheran Health System Inc Organization, La Crosse, WI Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 31, 2015 100%
Operational/Managerial Control Jul 31, 2015
Charles L Johnson Individual Corporate Director Jan 21, 2020
Julie Creery Individual W-2 Managing Employee Jan 21, 2020

Facilities with the same owner 49

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

View all 49

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": "1146873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659484800000",
    "number": "1083663397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 JEFFERSON ST",
            "city": "WEST UNION",
            "state": "IA",
            "postal_code": "521751024",
            "telephone_number": "563-422-6267",
            "fax_number": "563-422-9876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 JEFFERSON ST",
            "city": "WEST UNION",
            "state": "IA",
            "postal_code": "521751024",
            "telephone_number": "563-422-6267",
            "fax_number": "563-422-9876"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "230 2nd Ave SE",
            "address_purpose": "LOCATION",
            "city": "Oelwein",
            "state": "IA",
            "postal_code": "506622417",
            "country_code": "US",
            "telephone_number": "319-283-4489",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PALMER LUTHERAN HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GUNDERSEN LUTHERAN HEALTH SYSTEM",
        "enumeration_date": "2006-05-06",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A",
        "authorized_official_last_name": "KUENNEN",
        "authorized_official_first_name": "PATRICE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "563-422-3811"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "IA",
            "license": "330070H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gundersen Palmer Lutheran Hospital and Clinics - Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gundersen Palmer Lutheran Hospital and Clinics - Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Union, IA

Sources for this page

Verify at the official NPI Registry.