NPIMap

Organization Active NPI

Community Hospital Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Hamburg, IA
National Provider Identifier
1124114145
Registry record updated Jun 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
360067H Issued in IA
Legal business name
COMMUNITY HOSPITAL INC
Practice address
2959 US Highway 275
Hamburg, IA 51640-5052
Phone
(712) 382-1515
NPI assigned
Oct 5, 2006
Organization subpart
Yes
Parent organization
COMMUNITY HOSPITAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 1, 2022

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 360067H IA Primary
Critical Access Hospital 282NC0060X 360067H IA

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

Other names 1

  • George C. Grape Community Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070103000223 IA Part A Provider - Critical Access Hospital 6103860564 Receives reassigned benefits from 3 practitioners
Practice locations: Hamburg, IA

Hospital certification: CCN 16Z324

Legal name
COMMUNITY HOSPITAL INC
Doing business as
GEORGE C GRAPE COMMUNITY HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Sep 16, 1953 in IA
Enrollment address
2959 US Highway 275
Hamburg, IA 51640-5052
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Grape Community Hospita3 organizations share this tax ID, including this one
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.

Locations

1203 S Locust St
Ste 100
Glenwood, IA 51534
Phone (712) 527-4100

2967 US Highway 275
Ste 1
Hamburg, IA 51640

2959 US Highway 275
#C
Hamburg, IA 51640

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Cristin a Hendrickson Individual Corporate OfficerCeo/Administrator Nov 21, 2021
W-2 Managing EmployeeCeo/Administrator Nov 21, 2021
Operational/Managerial ControlCeo/Administrator Nov 21, 2021
Angela S Ettleman Individual Corporate Officer Feb 5, 2024
Corporate Director Feb 4, 2019
Michael J Ourada Individual Contracted Managing EmployeeChief of Staff Jan 1, 2024
Operational/Managerial ControlChief of Staff Jan 1, 2024
Arthur K Claiborne Individual Corporate Officer Feb 5, 2024
Corporate Director Feb 5, 2024
Thomas H Largen Individual Corporate Director Jul 23, 2025
Danny R Osborn Individual Corporate Director Feb 5, 2024
Troy D Hendrickson Individual Corporate Officer Feb 5, 2024
Corporate Director Feb 7, 2022
Melissa J Travis Individual Corporate Director Feb 5, 2024

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Medical ClinicTabor, IA, CCN 163836 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Dec 31, 2023
Dec 31, 2023
Medical ClinicHamburg, IA, CCN 163834 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Dec 31, 2023
Dec 31, 2023
Medical ClinicSidney, IA, CCN 163833 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.

  • Medical Clinic LLC
    • Rural Health Clinic/Center
    • Tabor, IA
    • NPI 1841263233

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Medical Clinic LLC
    • Rural Health Clinic/Center
    • Sidney, IA
    • NPI 1871566265

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Medical Clinic LLC
    • Rural Health Clinic/Center
    • Hamburg, IA
    • NPI 1972575595

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

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.

Practitioners & affiliated clinicians

Practitioners 6

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

Affiliated clinicians 1

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": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654041600000",
    "number": "1124114145",
    "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY HOSPITAL INC",
        "enumeration_date": "2006-10-05",
        "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": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "IA",
            "license": "360067H",
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IA",
            "license": "360067H",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "George C. Grape Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "George C. Grape Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hamburg, IA

Sources for this page

Verify at the official NPI Registry.