NPIMap

Organization Active NPI

Buena Vista Regional Medical Center

  • Emergency Medical Services (Emergency Medicine) Physician
  • Storm Lake, IA
National Provider Identifier
1164593109
Registry record updated Jul 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
166H Issued in IA
Legal business name
BUENA VISTA REGIONAL MEDICAL CENTER
Practice address
1525 W 5TH St
Storm Lake, IA 50588-3027
Phone
(712) 732-4030
Fax
(712) 213-1233
NPI assigned
Nov 13, 2006
Last updated
Jul 8, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2011

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

Authorized official

Name
Mrs. Krista L Ketcham
Title
Cfo
Phone
(712) 213-8603

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 166H IA Primary

Addresses

Primary practice location

1525 W 5TH St
Storm Lake, IA 50588-3027

Mailing address

1525 W 5TH St
PO Box 309
Storm Lake, IA 50588-3027
Phone (712) 732-4030

Other identifiers 2

IdentifierTypeStateIssuer
12089OtherIAWELLMARK GROUP NUMBER
0097956MedicaidIN

Other names 1

  • ER Physician Group Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040109001054 IA Part B Supplier - Clinic/Group Practice 3476464421 Receives reassigned benefits from 65 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cherokee, IA; Meriden, IA; Sac City, IA; Storm Lake, IA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Buena Vista Hosp Ambula8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

217 Main St
Coon Rapids, IA 50058
Phone (712) 999-2253

210 E 5th St
Storm Lake, IA 50588
Phone (515) 712-4750

620 Northwestern Dr
#4
Storm Lake, IA 50588
Phone (712) 213-8050

3840 W 9th St
Waterloo, IA 50702
Phone (319) 236-3858

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310083200000",
    "number": "1164593109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 W 5TH ST",
            "address_2": "PO BOX 309",
            "city": "STORM LAKE",
            "state": "IA",
            "postal_code": "505883027",
            "telephone_number": "712-732-4030",
            "fax_number": "712-213-1233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 W 5TH ST",
            "city": "STORM LAKE",
            "state": "IA",
            "postal_code": "505883027",
            "telephone_number": "712-732-4030",
            "fax_number": "712-213-1233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUENA VISTA REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2011-07-08",
        "status": "A",
        "authorized_official_last_name": "KETCHAM",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "712-213-8603",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "IA",
            "license": "166H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK GROUP NUMBER",
            "identifier": "12089",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0097956",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ER Physician Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Storm Lake, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.