Primary Health Care, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Des Moines, IA
NPI 1124177407 · NPPES record last updated Jan 7, 2026
Key facts
- NPI
- 1124177407
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- NA (IA)
- Legal business name
- PRIMARY HEALTH CARE, INC.
- Practice address
- 3509 E 29TH St
Des Moines, IA 50317-4253 - Phone
- (515) 248-1600
- Fax
- (515) 248-1610
- NPI assigned
- Jan 9, 2007
- Organization subpart
- No
Authorized official
- Name
- Nathaniel A Simpson
- Title
- Chief Executive Officer
- Phone
- (515) 248-1441
Other NPIs on the same Medicare enrollment 11
Other NPIs with the same Medicare PAC ID 12
Corporate family (same tax ID) 11
Practitioners 72
-
Nancy Ann Thurtell, ARNP
-
Christina Lynn Aguilar, ARNP
-
Stacy Jo Anderson, ARNP
-
Mary Ann Mercedes Be, ARNP
-
Sharon Bertroche, MD
-
Louise M Convery, D.O.
-
Angela De Hamer, DO
-
Aditi Derashri, MD
-
Korie Jordan Eischeid, ARNP
-
Patricia Ann Fasbender, D.O.
-
Staci Lynn Fosenburg, PH.D.
-
Amanda Mary Fry, PMHNP-BC
-
Lashelle Jean Goode, ARNP
-
Sarah Sweeney Gude, D.O.
-
Anneke Britt Gustafson, LISW
-
Kevin Hanigan, D.O.
-
Rachel Marie Harris, ARNP
-
Erin N Hernandez, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA
Federally qualified health center certification: CCN 161818
- Legal name
- PRIMARY HEALTH CARE INC
- Doing business as
- PRIMARY HEALTH CARE-EAST SIDE CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 14, 2003
- Last certification
- Mar 14, 2003
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 13, 1989 in IA
- Enrollment address
- 3509 E 29TH St
Des Moines, IA 50317-4253
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Billie Wade |
Corporate Director | May 1, 2012 | |
| Janet L Hicks |
Corporate Director | Jan 26, 2018 | |
| Sandra Hansen |
Corporate Director | Oct 1, 2014 | |
| Rachel Gooden |
Corporate Director |
Aug 16, 2021 | |
| Roger Alan Lacoy |
Corporate Director | Oct 30, 2015 | |
| Scott Clair |
Corporate Director | Apr 26, 2013 | |
| Juan Cadenillas |
Corporate Director | Jul 1, 2008 | |
| William Schoenenberger |
Corporate Director | Jul 1, 2008 | |
| Jennifer Nevins |
Corporate Director |
Nov 9, 2020 | |
| Benjamin E Bellus |
Corporate Director | Feb 3, 2003 | |
| Samuel M Carbajal |
Corporate Director | May 30, 2014 | |
| Sergio Hernandez |
Corporate Director | Jul 1, 2007 | |
| Denise Essman |
Corporate Director | Aug 31, 2018 | |
| Karin Jean Derry |
Corporate Director | May 27, 2016 | |
| Jennifer Lynne Nobisch |
Corporate Director | Jun 1, 2021 | |
| Kristopher Glaser |
Corporate Director | Jul 31, 2020 | |
| Ted Morris Johnson |
Corporate Director | May 27, 2016 | |
| Kelly a Huntsman |
Corporate Director |
Apr 29, 2002 | |
| W-2 Managing Employee |
Apr 29, 2002 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030203000010 | IA | Part a Provider - Federally Qualified Health Center (FQHC) | 8426966755 | Practice locations: Des Moines, IA |
| O20031106000487 | IA | Part B Supplier - Clinic/Group Practice | 8426966755 |
Receives reassigned benefits from 83 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Urbandale, IA; Marshalltown, IA; Des Moines, IA; Ames, IA |
National Provider Directory
- Tax ID family
- Primary Health Care Inc
Locations
1200 University Ave
Ste 200
Des Moines, IA 50314
Phone (515) 248-1447
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | NA | IA | Yes |
Addresses
Primary practice location
3509 E 29TH St
Des Moines, IA 50317-4253
Mailing address
1200 University Ave Ste 200
Des Moines, IA 50314-2355
Phone (515) 248-1447
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0281857 | Medicaid | IA | |
| 35586 | Other | IA | WELLMARK BCBS |
Other names
- Primary Health Care-East Side Clinic
Other providers in Des Moines, IA
- Heather Price
- Lizabeth Marie Price
- Micah Larvin Price
- Sarah Lynn Price
- Primary Health Care, Inc.
- Primary Health Care, Inc.
- Primary Health Care, Inc.
- Primary Health Care, Inc.
- Primary Health Care, Inc.
- Primary Health Care, Inc.
All providers in Des Moines, IA · Federally Qualified Health Center (FQHC) in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2026. 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.