NPIMap

Organization Active NPI

Infinity Health

  • Federally Qualified Health Center (FQHC)
  • Osceola, IA
National Provider Identifier
1124525647
Registry record updated Feb 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
INFINITY HEALTH
Practice address
219 W Washington St
Osceola, IA 50213-1249
Phone
(641) 342-9000
Fax
(515) 608-4692
NPI assigned
Apr 11, 2018
Organization subpart
Yes
Parent organization
INFINITY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 11, 2022

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

Authorized official

Name
Samantha Cannon
Title
Ceo
Phone
(641) 446-2383

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

219 W Washington St
Osceola, IA 50213-1249

Mailing address

302 NE 14TH St
Leon, IA 50144-1206
Phone (641) 446-2383

Other identifiers 2

IdentifierTypeStateIssuer
507202208MedicaidMO
0462887MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051024000374 IA Part B Supplier - Clinic/Group Practice 5597717496 Receives reassigned benefits from 27 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Albia, IA; Centerville, IA; Chariton, IA; Corydon, IA; Knoxville, IA; Lamoni, IA; Leon, IA; Mount Ayr, IA…
O20180830002267 IA Part A Provider - Federally Qualified Health Center (FQHC) 5597717496 Practice locations: Osceola, IA

Federally qualified health center certification: CCN 161878

Legal name
INFINITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 27, 2018
Last certification
Aug 27, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
219 W Washington St
Ste 100
Osceola, IA 50213-1249

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Infinity Health13 organizations share this tax ID, including this one
Part of
Infinity Health

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 10

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

NameRoleSinceShare
Brenda Fry Individual Other Mar 1, 2022 11.1%
Pamela Burlin Individual Other Nov 30, 2021 11.1%
Tanya Coffelt Individual Other Feb 28, 2023 11.1%
William Weaver Individual Other Apr 26, 2022 11.1%
Alan Wilson Individual Corporate DirectorAt-Large-Member Mar 23, 2010 10%
Other Mar 23, 2010
William Morain Individual Corporate Director Jan 1, 2005
Other Jan 1, 2005 11.1%
Mary Frisbie Individual Other Feb 28, 2023 11.1%
Kathleen Lerma Individual Other Mar 26, 2024 11.1%
Kyle E Ahlenstorf Individual Corporate DirectorCeo Dec 29, 2024
W-2 Managing EmployeeAd; Dec 29, 2024
Marvin McCann Individual Other Apr 27, 2021 11.1%

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1523404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644537600000",
    "number": "1124525647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 NE 14TH ST",
            "city": "LEON",
            "state": "IA",
            "postal_code": "501441206",
            "telephone_number": "641-446-2383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 W WASHINGTON ST",
            "city": "OSCEOLA",
            "state": "IA",
            "postal_code": "502131249",
            "telephone_number": "641-342-9000",
            "fax_number": "515-608-4692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFINITY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INFINITY HEALTH",
        "enumeration_date": "2018-04-11",
        "last_updated": "2022-02-11",
        "certification_date": "2022-02-11",
        "status": "A",
        "authorized_official_last_name": "CANNON",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "641-446-2383"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507202208",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0462887",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Osceola, IA

Sources for this page

Verify at the official NPI Registry.