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Belmond Community Hospital

Organization Active NPI Rural Health Clinic/Center · Hampton, IA

NPI 1114269339 · NPPES record last updated Jan 20, 2020

Key facts

NPI
1114269339
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
990169H (IA)
Legal business name
BELMOND COMMUNITY HOSPITAL
Practice address
700 2ND St SE
Suite 101
Hampton, IA 50441-2655
Phone
(641) 812-1094
Fax
(641) 812-1096
NPI assigned
Mar 26, 2013
Organization subpart
No

Authorized official

Name
Amy McDaniel
Title
Cfo
Phone
(641) 444-5621

Owners & managing parties with NPI records 6

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

Owned or controlled facilities with NPI records 3

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

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 6

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

Corporate family (same tax ID) 7

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

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

Facilities with the same owner 2

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

Practitioners 86

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 86

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2056273Hampton Clinic
700 2ND Street SE, Ste 101, Hampton, IA 50441		Certificate of waiverMar 24, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IA

Rural health clinic certification: CCN 168559

Legal name
BELMOND COMMUNITY HOSPITAL
Doing business as
HAMPTON CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 30, 2014
Last certification
Sep 9, 2021
Ownership / control type
Non-profit – church related
Organization structure
Other · Non-profit
Enrollment address
700 2ND St SE
Ste 101
Hampton, IA 50441-2658
Related CCNs
161301

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
Anna Buseman
Individual 		Corporate Director Jan 1, 2024
Gregory C Polzin
Individual 		Corporate Director Jul 1, 2014
Belmond Community Hospital
Organization · Belmond, IA
Non-profit 		Operational/Managerial Control Jan 1, 2000 100%
Teri Havens
Individual 		Corporate Director Feb 5, 2018
Brad Robson
Individual 		Corporate Director Jun 1, 2004
Missy Brannick
Individual 		W-2 Managing Employee Feb 5, 2018
Nancy Ann Gabrielson
Individual 		Corporate Director Mar 7, 2019
Troy Watne
Individual 		Corporate Director Jan 27, 2016
Kelly J Leu
Individual 		W-2 Managing Employee Oct 1, 2012
Amy McDaniel
Individual 		Corporate Officer
Chief Operations Officer		 Nov 1, 2013

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Iowa Specialty Hospital-Belmond
Belmond, IA · CCN 161301		 Hospital Operational/Managerial Control (100%) Dec 27, 2019
Iowa Specialty Hospital - Belmond
Belmond, IA · CCN 16Z301		 Hospital Operational/Managerial Control (100%) Jan 1, 2000

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20130426000161 IA Part a Provider - Rural Health Clinic 1052201852 1 other NPI on this enrollment
Practice locations: Hampton, IA

National Provider Directory

Tax ID family
Belmond Comm Hospital (8 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 990169H IA Yes

Addresses

Primary practice location

700 2ND St SE
Suite 101
Hampton, IA 50441-2655

Mailing address

403 1St St SE
Belmond, IA 50421-1201
Phone (641) 444-3500

Other names

  • Hampton Clinic Doing business as

Other providers in Hampton, IA

All providers in Hampton, IA · Rural Health Clinic/Center in Iowa

Sources for this page

Verify at the official NPI Registry.