NPIMap

Organization Active NPI

Avera Holy Family

  • Emergency Medicine Physician
  • Estherville, IA
National Provider Identifier
1124056338
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
AVERA HOLY FAMILY
Practice address
826 N 8TH St
Estherville, IA 51334-1528
Phone
(712) 362-2631
Fax
(712) 362-2636
NPI assigned
Jun 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2021

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

Authorized official

Name
Deb Herzberg
Title
Ceo
Phone
(712) 362-6160

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

826 N 8TH St
Estherville, IA 51334-1528

Mailing address

826 N 8TH St
Estherville, IA 51334-1528
Phone (712) 362-2631

Other identifiers 8

IdentifierTypeStateIssuer
0077057MedicaidIA
32245OtherIACARDIOLOGY SERV BL CR IA
677247100MedicaidMN
06272OtherIACRNA BL CR IA
0272773MedicaidIA
27277OtherIAER SERV BL CR IA
608921HOOtherBC MN CRNA
74065HOOtherMNER CARD BL MN

Other names 1

  • Avera Holy Family Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040205000405 IA Part B Supplier - Clinic/Group Practice 7113837428 Receives reassigned benefits from 33 practitioners
1 other NPI on this enrollment
Practice locations: Estherville, IA

Other NPIs with the same Medicare PAC ID 3

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.

National Provider Directory

National Provider Directory
Tax ID family
Holy Family Hospital5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Avera Holy Family HospitalEstherville, IA, CCN 161351 Hospital Operational/Managerial Control Nov 20, 2007

Owned or controlled facilities with NPI records 1

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

Practitioners 35

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

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625184000000",
    "number": "1124056338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 N 8TH ST",
            "city": "ESTHERVILLE",
            "state": "IA",
            "postal_code": "513341528",
            "telephone_number": "712-362-2631",
            "fax_number": "712-362-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 N 8TH ST",
            "city": "ESTHERVILLE",
            "state": "IA",
            "postal_code": "513341528",
            "telephone_number": "712-362-2631",
            "fax_number": "712-362-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA HOLY FAMILY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-28",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A",
        "authorized_official_last_name": "HERZBERG",
        "authorized_official_first_name": "DEB",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-362-6160"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0077057",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARDIOLOGY SERV BL CR IA",
            "identifier": "32245",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "677247100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRNA BL CR IA",
            "identifier": "06272",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0272773",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ER SERV BL CR IA",
            "identifier": "27277",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC MN CRNA",
            "identifier": "608921HO",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ER CARD BL MN",
            "identifier": "74065HO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Holy Family Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Holy Family Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Estherville, IA

Sources for this page

Verify at the official NPI Registry.