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Delaware County Memorial Hospital

Organization Active NPI Rural Health Clinic/Center · Winthrop, IA

NPI 1154474609 · NPPES record last updated May 28, 2013

Key facts

NPI
1154474609
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
280123H (IA)
Legal business name
DELAWARE COUNTY MEMORIAL HOSPITAL
Practice address
345 1St St S
Winthrop, IA 50682-9759
Phone
(319) 935-3343
Fax
(319) 935-3331
NPI assigned
Jan 19, 2007
Organization subpart
No

Authorized official

Name
Dr. Lon Butikofer, RN, PHD
Title
Ceo
Phone
(563) 927-7308

Owners & managing parties with NPI records 10

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

Owned or controlled facilities with NPI records 7

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

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 10

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

Corporate family (same tax ID) 11

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

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

Facilities with the same owner 6

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

Practitioners 84

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

View all 84

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0384756Regional Family Health Winthrop
345 First Street South, Winthrop, IA 50682		Certificate of waiverJan 25, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IA

Rural health clinic certification: CCN 168554

Legal name
DELAWARE COUNTY MEMORIAL HOSPITAL
Doing business as
REGIONAL FAMILY HEALTH WINTHROP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 22, 2013
Last certification
Feb 10, 2021
Ownership / control type
Non-profit – church related
Organization structure
Government · Non-profit
Enrollment address
345 1St St S
Winthrop, IA 50682-9759
Related CCNs
161343

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
Kathy Swift
Individual 		Corporate Director
Board Member		 Jan 2, 2023
John Zietlow
Individual 		Corporate Director
Board Member		 Aug 19, 2024 100%
Delaware County Memorial Hospital
Organization · Winthrop, IA 		Operational/Managerial Control Aug 1, 1966 100%
Jane Candace Sherman
Individual 		Corporate Director
Board Member		 Jan 2, 2023
Cathy Lilienthal
Individual 		Corporate Director
Board Member		 Sep 18, 2017
Steve H Palmer
Individual 		Corporate Director
Board Member		 Jun 1, 2004
Danette R Kramer
Individual 		Corporate Director
Ceo		 Mar 1, 2021 100%
W-2 Managing Employee
Ceo		 Feb 24, 2017 100%
Joe D Keith
Individual 		Corporate Director
Board Member		 Jan 2, 2001
Chris Tegeler
Individual 		Corporate Director
Board Member		 Jul 1, 2008

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Regional Medical Center
Manchester, IA · CCN 161343		 Hospital Operational/Managerial Control Aug 28, 2013
Regional Medical Center
Manchester, IA · CCN 16Z343		 Hospital Operational/Managerial Control Aug 28, 2013
Regional Family Health Edgewood
Edgewood, IA · CCN 168531		 Rural health clinic Operational/Managerial Control Jan 1, 1966
Regional Family Health Hopkinton
Hopkinton, IA · CCN 168529		 Rural health clinic Operational/Managerial Control Apr 1, 2009
Regional Family Health Manchester
Manchester, IA · CCN 168530		 Rural health clinic Operational/Managerial Control (100%) Apr 1, 2009
Regional Family Health Strawberry Point
Strawberry Point, IA · CCN 168528		 Rural health clinic Operational/Managerial Control Apr 1, 2009

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20120416000074 IA Part a Provider - Rural Health Clinic 2062316375 1 other NPI on this enrollment
Practice locations: Winthrop, IA

National Provider Directory

Tax ID family
Delaware County Hosp (12 organizations share this tax ID)

Locations

345 1st St S
Winthrop, IA 50682
Phone (319) 935-3343

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 280123H IA Yes

Addresses

Primary practice location

345 1St St S
Winthrop, IA 50682-9759

Mailing address

PO Box 359
Manchester, IA 52057-0359
Phone (563) 927-7457

Other identifiers

IdentifierTypeStateIssuer
0218305MedicaidIA
421213909OtherIACOMMERCIAL CARRIERS

Other names

  • Regional Family Health Winthrop Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 28, 2013.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369699200000",
    "number": "1154474609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 359",
            "city": "MANCHESTER",
            "state": "IA",
            "postal_code": "520570359",
            "telephone_number": "563-927-7457",
            "fax_number": "563-927-7557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 1ST ST S",
            "city": "WINTHROP",
            "state": "IA",
            "postal_code": "506829759",
            "telephone_number": "319-935-3343",
            "fax_number": "319-935-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELAWARE COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2013-05-28",
        "status": "A",
        "authorized_official_last_name": "BUTIKOFER",
        "authorized_official_first_name": "LON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "563-927-7308",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "RN, PHD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IA",
            "license": "280123H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0218305",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL CARRIERS",
            "identifier": "421213909",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Regional Family Health Winthrop",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winthrop, IA

All providers in Winthrop, IA · Rural Health Clinic/Center in Iowa

Sources for this page

Verify at the official NPI Registry.