Sioux Valley Memorial Hospital Association
Organization Active NPI Rural Health Clinic/Center · Holstein, IA
NPI 1174529283 · NPPES record last updated Oct 9, 2015
Key facts
- NPI
- 1174529283
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION
- Practice address
- 112 N Kiel St
Holstein, IA 51025-7717 - Phone
- (712) 368-4730
- Fax
- (712) 376-4709
- NPI assigned
- Jun 23, 2005
- Organization subpart
- No
Authorized official
- Name
- Joan M Bierman
- Title
- Cfo
- Phone
- (712) 225-1505
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 9
Related certifications (CCN) 1
Facilities with the same owner 11
Practitioners 21
-
Jani Lynn Boothby, ARNP
-
Kristin Kay Cedar, ARNP
-
Lisa M. Ducommun, CNP
-
Brooke Fiddelke, ARNP
-
Monica L Firme, CRNA
-
John Robert Greaves, DPM
-
Christopher M Hanson, CRNA
-
Jeannette Lee Hasley, ARNP, CNM
-
Wesley A. Parker, M.D.
-
Timothy G. Rice, D.O.
-
Abby J Tentinger, NP-C
-
Britt Juul Andersen, MD, PHD
-
Sharrod Reynard Greene, DNP, CRNA
-
Jeremy R Jensen, RN
-
Elias Kiptoo Melly, CRNA
-
Byron Leonard Perkinson, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 16D0891032 | Holstein Medical Clinic | Certificate of waiver | Sep 29, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
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
- Other · Non-profit
- Enrollment address
- 112 N Kiel St
Holstein, IA 51025-7717 - Related CCNs
- 161362
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Tyler Gerstandt |
Corporate Officer |
Apr 7, 2023 | |
| Kellen Ludvigson |
Corporate Director | Apr 12, 2021 | |
| Clay Leavitt |
Corporate Director | Apr 13, 2020 | |
| St. Luke'S Health System, Inc. |
Operational/Managerial Control | Oct 1, 2013 | |
| Leslie William Todd |
Corporate Director | Apr 13, 2015 | |
| Sheila Trapp |
Corporate Director |
Apr 9, 2018 | |
| Kerry Marie Hurd |
Corporate Director | Apr 12, 2022 | |
| Sarah Cook |
Corporate Director | Apr 11, 2016 | |
| Suzanne M. Sangwin |
W-2 Managing Employee | Sep 29, 2006 | |
| Gary W Jordan |
Contracted Managing Employee | Mar 18, 2019 | |
| Brandon Henke |
Corporate Director | Apr 12, 2021 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Heartland Care Center Inc |
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 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090512000375 | IA | Part a Provider - Rural Health Clinic | 4880501881 | Practice locations: Holstein, IA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0634410 | Medicaid | IA |
Other names
- Cherokee Regional Clinic - Holstein
Other providers in Holstein, IA
- Letsche Apothecary
- Myron Leonard Murphy
- Myron L Murphy DDS PC
- Abbie J Otto
- Alan Rush
- Edward Taylor
- The Evangelical Lutheran Good Samaritan Society
- The Evangelical Lutheran Good Samaritan Society
- Pamela Lynn Turpin
- Whitmer Spine & Sports Chiropractic
All providers in Holstein, IA · Rural Health Clinic/Center in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 9, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.