NPIMap

Organization Active NPI

Sioux Valley Memorial Hospital Association

Doing business as Cherokee Regional Clinic - Holstein

  • Rural Health Clinic/Center
  • Holstein, IA
National Provider Identifier
1174529283
Registry record updated Oct 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION
Doing business as
Cherokee Regional Clinic - Holstein
Practice address
112 N Kiel St
Holstein, IA 51025-7717
Phone
(712) 368-4730
Fax
(712) 376-4709
NPI assigned
Jun 23, 2005
Last updated
Oct 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2015

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

Authorized official

Name
Joan M Bierman
Title
Cfo
Phone
(712) 225-1505

Specialties & licenses 1

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

Addresses

Primary practice location

112 N Kiel St
Holstein, IA 51025-7717

Mailing address

300 Sioux Valley Dr
Cherokee, IA 51012-1205
Phone (712) 225-6265

Other names 1

  • Cherokee Regional Clinic - Holstein Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090512000375 IA Part A Provider - Rural Health Clinic 4880501881 Practice locations: Holstein, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174529283. Details of each certification follow.

Rural health clinic certification: CCN 163441

Legal name
SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION
Doing business as
HOLSTEIN MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 3, 1995
Last certification
Sep 15, 2021
Ownership / control type
1B
Organization structure
OtherNon-profit
Enrollment address
112 N Kiel St
Holstein, IA 51025-7717
Related CCNs
161362

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

Other NPIs with the same Medicare PAC ID 9

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0891032Holstein Medical Clinic112 North Kiel St, Holstein, IA 51025Certificate of waiverSep 29, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Tyler Gerstandt Individual Corporate OfficerCfo Apr 7, 2023
Kellen Ludvigson Individual Corporate Director Apr 12, 2021
Clay Leavitt Individual Corporate Director Apr 13, 2020
St. Luke's Health System, Inc. Organization, Sioux City, IA Non-profit Operational/Managerial Control Oct 1, 2013
Leslie William Todd Individual Corporate Director Apr 13, 2015
Sheila Trapp Individual Corporate DirectorBoard Member Apr 9, 2018
Kerry Marie Hurd Individual Corporate Director Apr 12, 2022
Sarah Cook Individual Corporate Director Apr 11, 2016
Suzanne M. Sangwin Individual W-2 Managing Employee Sep 29, 2006
Gary W Jordan Individual Contracted Managing Employee Mar 18, 2019
Brandon Henke Individual Corporate Director Apr 12, 2021

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Heartland Care Center IncMarcus, IA, CCN 165397 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Jul 19, 2023
Jul 19, 2023
Jul 19, 2023

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 11

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

NPI Registry JSON

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444348800000",
    "number": "1174529283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SIOUX VALLEY DR",
            "city": "CHEROKEE",
            "state": "IA",
            "postal_code": "510121205",
            "telephone_number": "712-225-6265",
            "fax_number": "712-225-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 N KIEL ST",
            "city": "HOLSTEIN",
            "state": "IA",
            "postal_code": "510257717",
            "telephone_number": "712-368-4730",
            "fax_number": "712-376-4709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2015-10-09",
        "status": "A",
        "authorized_official_last_name": "BIERMAN",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "712-225-1505"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cherokee Regional Clinic - Holstein",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holstein, IA

Sources for this page

Verify at the official NPI Registry.