NPIMap

Organization Active NPI

Crawford County Memorial Hospital

Doing business as CCMH Medical Clinic

  • Rural Health Clinic/Center
  • Denison, IA
National Provider Identifier
1104893700
Registry record updated Aug 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CRAWFORD COUNTY MEMORIAL HOSPITAL
Doing business as
CCMH Medical Clinic
Practice address
100 Medical Pkwy Ste a
Denison, IA 51442-2614
Phone
(712) 265-2700
NPI assigned
Mar 2, 2006
Last updated
Aug 18, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
CRAWFORD COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 18, 2026

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

Authorized official

Name
Erin C Muck
Title
President/Ceo
Phone
(712) 265-2506

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Rural Health Clinic/Center 261QR1300X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

100 Medical Pkwy Ste a
Denison, IA 51442-2614

Mailing address

100 Medical Pkwy
Ste a
Denison, IA 51442-2614
Phone (712) 265-2700

Other names 1

  • CCMH Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040129000821 IA Part B Supplier - Clinic/Group Practice 7810890555 Receives reassigned benefits from 31 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Denison, IA
O20090720000414 IA Part A Provider - Rural Health Clinic 7810890555 Practice locations: Denison, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104893700. Details of each certification follow.

Rural health clinic certification: CCN 168535

Legal name
CRAWFORD COUNTY MEMORIAL HOSPITAL
Doing business as
CCMH MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 2009
Last certification
Dec 6, 2016
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
100 Medical Pkwy
Ste a&B
Denison, IA 51442-2607
Related CCNs
161369

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Crawford Co Mem Hosp ER

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

100 Medical Pkwy
Ste 100
Denison, IA 51442

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Erin C Muck Individual Corporate OfficerPresident/Ceo Aug 1, 2019
W-2 Managing EmployeePresident/Ceo Aug 1, 2019
Operational/Managerial ControlPresident/Ceo Aug 1, 2019
David J Reisz Individual Corporate Director Jan 1, 2021
Michael Patrick Luft Individual W-2 Managing EmployeeMD; Sep 1, 2024
Operational/Managerial ControlMedical Director Sep 1, 2024
Rachel R Melby Individual Corporate OfficerCfo Apr 30, 2018
W-2 Managing EmployeeCfo Oct 27, 2014
Operational/Managerial ControlCfo Oct 27, 2014
Jon Schuttinga Individual Corporate Director Aug 28, 2023
Amy M Schultz Individual Corporate Officer Jan 1, 2022
Corporate Director Jan 1, 2021
Jason Richard Mendlik Individual Corporate Officer Jan 1, 2020
Corporate Director Jan 1, 2017
Vernon S Leise Individual Corporate Officer Jan 1, 2021
Corporate Director Jan 1, 2019
Travis Mettenbrink Individual W-2 Managing EmployeeAd;Director of Clinics Nov 27, 2023
Operational/Managerial ControlDirector of Clinics Nov 27, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787011200000",
    "number": "1104893700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MEDICAL PKWY",
            "address_2": "STE A",
            "city": "DENISON",
            "state": "IA",
            "postal_code": "514422614",
            "telephone_number": "712-265-2700",
            "fax_number": "712-263-1777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL PKWY STE A",
            "city": "DENISON",
            "state": "IA",
            "postal_code": "514422614",
            "telephone_number": "712-265-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRAWFORD COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CRAWFORD COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2006-03-02",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A",
        "authorized_official_last_name": "MUCK",
        "authorized_official_first_name": "ERIN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "712-265-2506"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCMH Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CCMH Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Denison, IA

Sources for this page

Verify at the official NPI Registry.