Active NPI
Community Hospital Inc
- Emergency Medicine Physician
- Hamburg, IA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- Legal business name
- COMMUNITY HOSPITAL INC
- Practice address
- 2959 US Highway 275
Hamburg, IA 51640-5052 - Phone
- (712) 382-1515
- Fax
- (712) 382-2023
- NPI assigned
- Oct 2, 2006
- Organization subpart
- Yes
- Parent organization
- COMMUNITY HOSPITAL INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Cristin A Hendrickson
- Title
- Ceo/Administrator
- Phone
- (712) 382-1515
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | Primary | ||
| Internal Medicine Physician | 207R00000X | |||
| Nurse Practitioner | 363L00000X | |||
| Certified Registered Nurse Anesthetist | 367500000X |
Addresses
Primary practice location
2959 US Highway 275
Hamburg, IA 51640-5052
Mailing address
2959 US Highway 275
Hamburg, IA 51640-5052
Phone (712) 382-1515
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050616000187 | IA | Part B Supplier - Clinic/Group Practice | 6103860564 |
Receives reassigned benefits from 6 practitioners Practice locations: Hamburg, IA |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- Medicare Defined Swing Bed Hospital Unit
- Hamburg, IA
- NPI 1124114145
6103860564
National Provider Directory
National Provider Directory- Tax ID family
- Grape Community Hospita
- Part of
- Grape Community Hospita
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Medicare Defined Swing Bed Hospital Unit
- Hamburg, IA
- NPI 1124114145
-
- Critical Access Hospital
- Hamburg, IA
- NPI 1932294071
Member organizations 3
Organizations listed as members of this organization in the National Provider Directory.
Ownership & related parties
All facility ownership & control disclosures 3
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Medical Clinic | Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Dec 31, 2023 Dec 31, 2023 |
| Medical Clinic | Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Dec 31, 2023 Dec 31, 2023 |
| Medical Clinic | Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Dec 31, 2023 Dec 31, 2023 |
Owned or controlled facilities with NPI records 3
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- Rural Health Clinic/Center
- Tabor, IA
- NPI 1841263233
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
- Rural Health Clinic/Center
- Sidney, IA
- NPI 1871566265
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
- Rural Health Clinic/Center
- Hamburg, IA
- NPI 1972575595
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Critical Access Hospital
- Hamburg, IA
- NPI 1932294071
Practitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Certified Registered Nurse Anesthetist
- Hamburg, IA
- NPI 1487792131
IA, Nurse Anesthetist, Certified Registered
-
- Family Medicine Physician
- Hamburg, IA
- NPI 1285606731
Family Medicine, IA
-
- Sports Medicine (Orthopaedic Surgery) Physician
- Council Bluffs, IA
- NPI 1083000905
IA
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1654041600000",
"number": "1124112677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2959 US HIGHWAY 275",
"city": "HAMBURG",
"state": "IA",
"postal_code": "516405052",
"telephone_number": "712-382-1515",
"fax_number": "712-382-2023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2959 US HIGHWAY 275",
"city": "HAMBURG",
"state": "IA",
"postal_code": "516405052",
"telephone_number": "712-382-1515",
"fax_number": "712-382-2023"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COMMUNITY HOSPITAL INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COMMUNITY HOSPITAL INC",
"enumeration_date": "2006-10-02",
"last_updated": "2022-06-01",
"certification_date": "2022-06-01",
"status": "A",
"authorized_official_last_name": "HENDRICKSON",
"authorized_official_first_name": "CRISTIN",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "CEO/ADMINISTRATOR",
"authorized_official_telephone_number": "712-382-1515"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Emergency Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": null,
"license": null,
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Anesthetist, Certified Registered",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hamburg, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.