NPIMap

Organization Active NPI

Human Services-Cherokee

  • Psychiatric Hospital
  • Cherokee, IA
National Provider Identifier
1093713307
Registry record updated Mar 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
121H Issued in IA
Legal business name
HUMAN SERVICES-CHEROKEE
Practice address
1251 W Cedar Loop
Cherokee, IA 51012-1566
Phone
(712) 225-2594
Fax
(712) 225-6904
NPI assigned
Jul 11, 2005
Last updated
Mar 8, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2013

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

Authorized official

Name
Dr. Jason Smith, PH.D.
Title
Superintendent
Phone
(712) 225-2594

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 121H IA Primary

Addresses

Primary practice location

1251 W Cedar Loop
Cherokee, IA 51012-1566

Mailing address

1251 W Cedar Loop
Cherokee, IA 51012-1599
Phone (712) 225-2594

Other identifiers 1

IdentifierTypeStateIssuer
0640029MedicaidIA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040323001445 IA Part B Supplier - Clinic/Group Practice 9335030899 Receives reassigned benefits from 8 practitioners
Practice locations: Cherokee, IA
O20210826002847 IA Part A Provider - Hospital 9335030899 Practice locations: Cherokee, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093713307. Details of each certification follow.

Hospital certification: CCN 164002

Legal name
HUMAN SERVICES-CHEROKEE
Doing business as
CHEROKEE MENTAL HEALTH INSTITUTE
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 1, 1966
Last certification
Apr 9, 2003
Beds
97
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
1251 W Cedar Loop
Cherokee, IA 51012-1566
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Care Compare: Hospital

Medicare Care Compare
Listed as
Mental Health InstituteCCN 164002 · All quality measures
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
16D0666087Cherokee Mental Health Institute1251 West Cedar Loop, Cherokee, IA 51012Certificate of waiverOct 31, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Cory Turner Individual Corporate Director Jun 1, 2015
W-2 Managing Employee Jun 1, 2015
Operational/Managerial Control Jun 1, 2015
Debra Koch Individual Operational/Managerial Control Jul 1, 2016
Human Services-Cherokee Organization, Cherokee, IA Non-profit 5% Or Greater Direct Ownership Interest Jan 8, 2012
Chris Tofteberg Individual W-2 Managing Employee Aug 16, 2010
Operational/Managerial Control Aug 16, 2010

Practitioners & affiliated clinicians

Practitioners 9

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": "1121040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362700800000",
    "number": "1093713307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1251 W CEDAR LOOP",
            "city": "CHEROKEE",
            "state": "IA",
            "postal_code": "510121599",
            "telephone_number": "712-225-2594",
            "fax_number": "712-225-6904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1251 W CEDAR LOOP",
            "city": "CHEROKEE",
            "state": "IA",
            "postal_code": "510121566",
            "telephone_number": "712-225-2594",
            "fax_number": "712-225-6904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMAN SERVICES-CHEROKEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-11",
        "last_updated": "2013-03-08",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "712-225-2594",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "IA",
            "license": "121H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0640029",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cherokee, IA

Sources for this page

Verify at the official NPI Registry.