Waverly Health Center
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Waverly, IA
NPI 1124043153 · NPPES record last updated Jun 5, 2024
Key facts
- NPI
- 1124043153
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- 090098H (IA)
- Legal business name
- WAVERLY HEALTH CENTER
- Practice address
- 312 9TH St SW
Waverly, IA 50677-2929 - Phone
- (319) 352-4120
- Fax
- (319) 352-3992
- NPI assigned
- Jul 12, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- WAVERLY HEALTH CENTER
Authorized official
- Name
- Ms. Jodi M Geerts
- Title
- Ceo
- Phone
- (319) 352-4120
Owners & managing parties with NPI records 2
-
Renu Bansal, MD
-
David J Rathe, DO
Other NPIs with the same Medicare PAC ID 9
Corporate family (same tax ID) 11
Related certifications (CCN) 1
Practitioners 44
-
Michael Jeremy Anderson, CRNA
-
Renu Bansal, MD
-
Natasha Jean Broom, CRNA
-
Clay R Dahlquist, DO
-
Jan Paula Davis, ARNP
-
Elizabeth Joy Dupic, M.D.
-
Nathan Collin Froehner, CRNA
-
Melissa Tiffiny Garrett, M.D.
-
David Edward Henry, M.D.
-
Tara Hensley, PA-C
-
Nicole Hickman, STUDENT
-
Kaitlin Hilmer, ARNP, FNP-C
-
Shannon E Hull, PAC
-
Troy Donovan Ivey, D.O.
-
Ellen Elizabeth Jacque, ARNP
-
Carissa Jo Kelm, ARNP
-
Tiffanie Lapan, DMPNA, CRNA, SRNP
-
Megan McMillin, PA
Affiliated clinicians 2
-
Rachel Lee Vaughn, ARNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Hospital certification: CCN 16Z339
- Legal name
- WAVERLY HEALTH CENTER
- Doing business as
- WAVERLY HEALTH CENTER
- Organization structure
- Other · Non-profit
- Enrollment address
- 312 9TH St SW
Waverly, IA 50677-2929
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Renu Bansal |
W-2 Managing Employee |
Jan 1, 2023 | |
| Operational/Managerial Control |
Jan 1, 2023 | ||
| Kelly a Hilsenbeck |
W-2 Managing Employee |
Feb 19, 2023 | |
| Operational/Managerial Control |
Feb 19, 2023 | ||
| Ann Henninger Trax |
Corporate Officer | Jan 7, 2022 | |
| Corporate Director | Jan 1, 2020 | ||
| Jodi M Geerts |
Corporate Officer |
Jan 18, 2023 | |
| W-2 Managing Employee |
Jan 18, 2023 | ||
| Operational/Managerial Control |
Jan 18, 2023 | ||
| Philip S Jones |
Corporate Officer | Jan 7, 2022 | |
| Corporate Director | Aug 31, 2021 | ||
| David J Rathe |
Corporate Director | Jan 1, 2024 | |
| Laurie Everhardt |
Corporate Director | Jan 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070129000176 | IA | Part a Provider - Critical Access Hospital | 8820996762 | Practice locations: Waverly, IA |
National Provider Directory
- Tax ID family
- Waverly Municipal Hospital
- Part of
- Waverly Municipal Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 090098H | IA | Yes |
| Critical Access Hospital | 282NC0060X | 090098H | IA |
Addresses
Primary practice location
312 9TH St SW
Waverly, IA 50677-2929
Mailing address
312 9TH St SW
Waverly, IA 50677-2929
Phone (319) 352-4120
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 66094 | Other | IA | BCBS SWING |
Other names
- Waverly Municipal Hospital
Other providers in Waverly, IA
- Waverly Chiropractic Specialties
- Waverly Chiropractic, PLC
- Waverly Family Dentistry LLC
- Waverly Health Center
- Waverly Health Center
- Waverly Health Center
- Waverly Health Center
- Waverly Health Center
- Waverly Health Center
- Waverly Health Center
All providers in Waverly, IA · Medicare Defined Swing Bed Hospital Unit in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.