NPIMap

Organization Active NPI

Belmond Community Hospital

Doing business as Hampton Clinic

  • Rural Health Clinic/Center
  • Hampton, IA
National Provider Identifier
1114269339
Registry record updated Jan 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
990169H Issued in IA
Legal business name
BELMOND COMMUNITY HOSPITAL
Doing business as
Hampton Clinic
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
Last updated
Jan 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2020

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

Authorized official

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

Specialties & licenses 1

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

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 1

  • Hampton Clinic Doing business as

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114269339. Details of each certification follow.

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
OtherNon-profit
Enrollment address
700 2ND St SE
Ste 101
Hampton, IA 50441-2658
Related CCNs
161301

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 1

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

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
16D2056273Hampton Clinic700 2ND Street SE, Ste 101, Hampton, IA 50441Certificate of waiverMar 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Clarine I Coker MD8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

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 OfficerChief Operations Officer Nov 1, 2013

Owners & managing parties with NPI records 6

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

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

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 2

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

NPI Registry JSON

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

{
    "created_epoch": "1364256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579478400000",
    "number": "1114269339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 1ST ST SE",
            "city": "BELMOND",
            "state": "IA",
            "postal_code": "504211201",
            "telephone_number": "641-444-3500",
            "fax_number": "641-444-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 2ND ST SE",
            "address_2": "SUITE 101",
            "city": "HAMPTON",
            "state": "IA",
            "postal_code": "504412655",
            "telephone_number": "641-812-1094",
            "fax_number": "641-812-1096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELMOND COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-26",
        "last_updated": "2020-01-20",
        "certification_date": "2020-01-20",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "641-444-5621"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IA",
            "license": "990169H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hampton Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hampton Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hampton, IA

Sources for this page

Verify at the official NPI Registry.