Hiawatha Medical Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

331637 Issued in MN

Legal business name

HIAWATHA MEDICAL INC

Practice address

4920 Moundview Dr
Suite B
Red Wing, MN 55066-1100

Phone

(651) 388-2223

NPI assigned

Jul 3, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Stephen L Staats

Title

Cfo

Phone

(651) 388-2223

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Hiawatha Homecare Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Home health agency certification: CCN 247288

Legal name

HIAWATHA MEDICAL INC

Doing business as

HIAWATHA HOMECARE

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Aug 26, 1993

Last certification

Oct 18, 2019

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Apr 15, 1988 in DE

Enrollment address

4920 Moundview Dr
# B
Red Wing, MN 55066-4532
HHA Branch

Listed as

Hiawatha HomecareCCN 247288

Overall star rating

2 of 5

Ownership

Proprietary

Certified

Aug 26, 1993

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Home health aide, Physical therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

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

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Bradley L Houston, MD

  • Family Medicine Physician
  • Red Wing, MN
  • NPI 1275529240

  Home health agency

  Care Compare affiliation
• Brian Timothy Malyon, MD

  • Family Medicine Physician
  • Red Wing, MN
  • NPI 1629043070

  Home health agency

  Care Compare affiliation
• Jennifer M Radtke, MD

  • Internal Medicine Physician
  • Red Wing, MN
  • NPI 1316912793

  Home health agency

  Care Compare affiliation
• Anna Tipton, FNP, DNP

  • Nurse Practitioner
  • Red Wing, MN
  • NPI 1063056935

  Home health agency

  Care Compare affiliation
• Melinda Louann Wiese, APRN, DNP

  • Nurse Practitioner
  • Owatonna, MN
  • NPI 1801313796

  Home health agency

  Care Compare affiliation

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144250481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4920 MOUNDVIEW DR",
            "address_2": "SUITE B",
            "city": "RED WING",
            "state": "MN",
            "postal_code": "550661100",
            "telephone_number": "651-388-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4920 MOUNDVIEW DR",
            "address_2": "SUITE B",
            "city": "RED WING",
            "state": "MN",
            "postal_code": "550661100",
            "telephone_number": "651-388-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIAWATHA MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STAATS",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "651-388-2223",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "331637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBCMN PROVIDER #",
            "identifier": "9266HI",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41533600",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA INS PROVIDER #",
            "identifier": "59-00045",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFFERED ONE PROVIDER #",
            "identifier": "1007436",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE PROVIDER #",
            "identifier": "125651",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hiawatha Homecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Sue Michelle Helm, D.O.
• Megan Herbers, DNP
• Cory David Hermann, LPCC (MN) LPC (WI)
• Katey Jill Hernandez Valeriano
• Gary Edward Hertog, PSY.D.
• Hiawatha Valley Mental Health Center
• Steven James Higbee
• Thanh Cong Hoang, APRN, CNP
• Sherrill Lee Holmes, CRNA
• Madelyne Kay Horne

• Home Health Agency in Red Wing, MN
• Providers in Red Wing, MN by specialty
• Home Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.