NPIMap

Organization Active NPI

Ellsworth Municipal Hospital

  • Rural Health Clinic/Center
  • Zearing, IA
National Provider Identifier
1144853516
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ELLSWORTH MUNICIPAL HOSPITAL
Practice address
112 W Main St
Zearing, IA 50278-7728
Phone
(641) 487-7800
Fax
(641) 487-7803
NPI assigned
Feb 13, 2020
Last updated
Nov 25, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ELLSWORTH MUNICIPAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Authorized official

Name
George Von Mock
Title
Ceo
Phone
(641) 648-7010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

112 W Main St
Zearing, IA 50278-7728

Mailing address

112 W Main St
Zearing, IA 50278-7728
Phone (641) 487-7800

Other names 1

  • Nesco Family Medical Clinic Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address HIM@elmhn.cernerdirect.com Direct

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040212000269 IA Part B Supplier - Clinic/Group Practice 2668366311 Receives reassigned benefits from 39 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ackley, IA; Iowa Falls, IA; Zearing, IA
O20200423002942 IA Part A Provider - Rural Health Clinic 2668366311 Practice locations: Zearing, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144853516. Details of each certification follow.

Rural health clinic certification: CCN 168642

Legal name
ELLSWORTH MUNICIPAL HOSPITAL
Doing business as
NESCO FAMILY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 15, 2020
Last certification
Jun 15, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
112 W Main St
PO Box 145
Zearing, IA 50278-7728
Related CCNs
161380

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).

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
Lance F Yeoman DO6 organizations share this tax ID, including this one
Part of
Lance F Yeoman DO

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
George Vonmock Individual Corporate OfficerCeo Jul 1, 2021
W-2 Managing EmployeeCeo Apr 1, 2019 5%
Ellsworth Municipal Hospital Organization, Iowa Falls, IA Created for acquisition, Chain home office 5% Or Greater Direct Ownership Interest Dec 10, 2018 100%
Quinn a Hoversten Individual Corporate OfficerBoard Member Apr 1, 2020
Marianne Jones Individual Corporate OfficerBoard Member Apr 1, 2020
Adam Nederhoff Individual Corporate OfficerBoard Member Jan 1, 2023
Prentice Lofstedt Individual Corporate OfficerBoard Member Jan 1, 2023
Darla Nederhoff Individual W-2 Managing EmployeeDirector of Clinics Jan 21, 1990
Shane Coughenour Individual Corporate OfficerCfo Mar 27, 2023
W-2 Managing Employee Mar 27, 2023
Amanda a Wood Individual Corporate OfficerBoard Member Apr 1, 2020

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Hansen Family HospitalIowa Falls, IA, CCN 161380 Hospital Operational/Managerial Control (100%) Nov 30, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1144853516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 W MAIN ST",
            "city": "ZEARING",
            "state": "IA",
            "postal_code": "502787728",
            "telephone_number": "641-487-7800",
            "fax_number": "641-487-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 W MAIN ST",
            "city": "ZEARING",
            "state": "IA",
            "postal_code": "502787728",
            "telephone_number": "641-487-7800",
            "fax_number": "641-487-7803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLSWORTH MUNICIPAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ELLSWORTH MUNICIPAL HOSPITAL",
        "enumeration_date": "2020-02-13",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "VON MOCK",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "641-648-7010"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "HIM@elmhn.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Hansen Family Hospital Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "920 S Oak St",
            "city": "Iowa Falls",
            "state": "IA",
            "country_code": "US",
            "postal_code": "501269506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Nesco Family Medical Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Nesco Family Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Zearing, IA

Sources for this page

Verify at the official NPI Registry.