NPIMap

Organization Active NPI

Waverly Health Center

  • Medicare Defined Swing Bed Hospital Unit
  • Waverly, IA
National Provider Identifier
1124043153
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
090098H Issued in 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
Last updated
Jun 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
WAVERLY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Authorized official

Name
Ms. Jodi M Geerts
Title
Ceo
Phone
(319) 352-4120

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 090098H IA Primary
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 names 1

  • Waverly Municipal Hospital Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070129000176 IA Part A Provider - Critical Access Hospital 8820996762 Practice locations: Waverly, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124043153. Details of each certification follow.

Hospital certification: CCN 16Z339

Legal name
WAVERLY HEALTH CENTER
Doing business as
WAVERLY HEALTH CENTER
Organization structure
OtherNon-profit
Enrollment address
312 9TH St SW
Waverly, IA 50677-2929
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Waverly ER Physician SV13 organizations share this tax ID, including this one
Part of
Waverly ER Physician SV

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Renu Bansal Individual W-2 Managing EmployeePresident of Medical Staff Jan 1, 2023
Operational/Managerial ControlPresident of Medical Staff Jan 1, 2023
Kelly a Hilsenbeck Individual W-2 Managing EmployeeCno Feb 19, 2023
Operational/Managerial ControlCno Feb 19, 2023
Ann Henninger Trax Individual Corporate Officer Jan 7, 2022
Corporate Director Jan 1, 2020
Jodi M Geerts Individual Corporate OfficerCeo Jan 18, 2023
W-2 Managing EmployeeCeo Jan 18, 2023
Operational/Managerial ControlCeo Jan 18, 2023
Philip S Jones Individual Corporate Officer Jan 7, 2022
Corporate Director Aug 31, 2021
David J Rathe Individual Corporate Director Jan 1, 2024
Laurie Everhardt Individual Corporate Director Jan 1, 2022

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1124043153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 9TH ST SW",
            "city": "WAVERLY",
            "state": "IA",
            "postal_code": "506772929",
            "telephone_number": "319-352-4120",
            "fax_number": "319-352-3992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 9TH ST SW",
            "city": "WAVERLY",
            "state": "IA",
            "postal_code": "506772929",
            "telephone_number": "319-352-4120",
            "fax_number": "319-352-3992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAVERLY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAVERLY HEALTH CENTER",
        "enumeration_date": "2006-07-12",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "GEERTS",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "319-352-4120",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "IA",
            "license": "090098H",
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IA",
            "license": "090098H",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waverly Municipal Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Waverly, IA

Sources for this page

Verify at the official NPI Registry.