Palmer Lutheran Health Center, Inc.
Organization Active NPI Community Based Hospice Care Agency · West Union, IA
NPI 1083663397 · NPPES record last updated Aug 3, 2022
Key facts
- NPI
- 1083663397
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 330070H (IA)
- Legal business name
- PALMER LUTHERAN HEALTH CENTER, INC.
- Practice address
- 200 Jefferson St
West Union, IA 52175-1024 - Phone
- (563) 422-6267
- Fax
- (563) 422-9876
- NPI assigned
- May 6, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- GUNDERSEN LUTHERAN HEALTH SYSTEM
Authorized official
- Name
- Patrice Kuennen
- Title
- Ceo
- Phone
- (563) 422-3811
Other NPIs with the same Medicare PAC ID 9
Corporate family (same tax ID) 11
Facilities with the same owner 49
Practitioners 37
-
Melinda Sue Brokaw, CNP ARNP
-
Darcy H Connelly, PA
-
Rhonda Ann Cue, ARNP
-
Andrea Kaye Dietzenbach, P.A.
-
Gabrielle Icele Flynt, DNP, CNP, ACNPC-AG
-
Kylie Lynn Jirak, CNM
-
Sheena Lee Kremer, ARNP
-
Mary Katherine Lilly, LICSW
-
Jessica A Loban, NP
-
Lisa Marie Myers, NP
-
Nicole Ann Payne, NP
-
Jill Marie Schmitt, ARNP
-
Rachel Ann Schroeder, FNP
-
Nichole Marie Steffens, PA-C
-
Brooke A Tappe, DPM
-
Geralyn R Zuercher, M.D.
-
Keith Edward Baynes, M.D.
Affiliated clinicians 2
-
Geralyn R Zuercher, M.D.
Medicare Care Compare: Hospice
- Listed as
- Gundersen Palmer Lutheran Hosp and Clinics-Hospice
- Ownership
- Non-Profit
- Certified
- Mar 19, 1992
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
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
- Corporation · Non-profit
- Enrollment address
- 200 Jefferson St
West Union, IA 52175-1024
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Rachel Kathryn Albrecht |
Corporate Director | Jan 1, 2023 | |
| Kristi M Flack |
Corporate Director |
Jan 24, 2018 | |
| Thomas Tornstrom |
Corporate Director | Jan 1, 2023 | |
| Nicole Havenstrite |
Corporate Director |
Jan 1, 2024 | |
| Patrice R Kuennen |
Corporate Officer |
Oct 8, 2018 | |
| W-2 Managing Employee |
Oct 8, 2018 | ||
| Brenda S Moser |
Corporate Officer |
Jan 1, 2025 | |
| Bellin Gundersen Health System Inc |
5% Or Greater Indirect Ownership Interest | Nov 30, 2022 | 100% |
| Operational/Managerial Control | Nov 30, 2022 | 100% | |
| Jodi Webb |
Corporate Director |
Jan 1, 2025 | |
| Gundersen Lutheran Health System Inc |
5% Or Greater Direct Ownership Interest | Jul 31, 2015 | 100% |
| Operational/Managerial Control | Jul 31, 2015 | ||
| Charles L Johnson |
Corporate Director | Jan 21, 2020 | |
| Julie Creery |
W-2 Managing Employee | Jan 21, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040303000980 | IA | Part a Provider - Hospice | 4284544255 | Practice locations: Oelwein, IA; West Union, IA |
National Provider Directory
- Tax ID family
- Palmer Lutheran HLTH Center
Locations
610 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-4311
1207 Mulberry Ln
La Crosse, WI 54603
Phone (608) 775-0950
2615 George St
La Crosse, WI 54603
601 N Superior Ave
Tomah, WI 54660
Phone (608) 374-3853
407 S Main St
Ste 103
Viroqua, WI 54665
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 330070H | IA | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 161521 | Other | IA | BLUE CROSS HOSPICE |
| 615211 | Medicaid | IA |
Other names
- Gundersen Palmer Lutheran Hospital and Clinics - Hospice
Other providers in West Union, IA
- Palmer Lutheran Health Center, Inc
- Palmer Lutheran Health Center, Inc
- Palmer Lutheran Health Center, Inc
- Palmer Lutheran Health Center, Inc
- Palmer Lutheran Health Center, Inc
- Palmer Lutheran Health Center, Inc.
- Palmer Lutheran Health Center, Inc.
- Palmer Lutheran Health Center, Inc.
- Palmer Outpatient Pharmacy
- Autumnn Parmeter
All providers in West Union, IA · Community Based Hospice Care Agency in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.