NPIMap

Organization Active NPI

Wayne County Hospital

  • Critical Access Hospital
  • Corydon, IA
National Provider Identifier
1174599468
Registry record updated Jul 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
WAYNE COUNTY HOSPITAL
Practice address
417 S East St
Corydon, IA 50060-1860
Phone
(641) 872-2260
Fax
(641) 872-3116
NPI assigned
Feb 27, 2006
Last updated
Jul 28, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2016

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

Authorized official

Name
Susan Henderson
Title
Director, Administrative Services
Phone
(641) 872-5341

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X
Surgery Physician 208600000X
Foot & Ankle Surgery Podiatrist 213ES0103X
Critical Access Hospital 282NC0060X Primary
Land Ambulance 3416L0300X

Addresses

Primary practice location

417 S East St
Corydon, IA 50060-1860

Mailing address

PO Box 305
Corydon, IA 50060-0305
Phone (641) 872-5341

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040212000233 IA Part B Supplier - Clinic/Group Practice 4082508734 Receives reassigned benefits from 59 practitioners
7 other NPIs on this enrollment
Practice locations: Corydon, IA; Humeston, IA; Seymour, ID
O20061104000298 IA Part A Provider - Critical Access Hospital 4082508734 Receives reassigned benefits from 12 practitioners
Practice locations: Corydon, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174599468. Details of each certification follow.

Hospital certification: CCN 161358

Legal name
WAYNE COUNTY HOSPITAL
Doing business as
WAYNE COUNTY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Aug 1, 2004
Last certification
May 18, 2023
Beds
25
Ownership / control type
Local
Organization structure
GovernmentNon-profit
Enrollment address
417 S East St
Corydon, IA 50060-1860

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

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 6

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Wayne County HospitalCCN 161358 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

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
Denise a Hook Individual Corporate OfficerChief Financial Officer Oct 1, 2013
W-2 Managing Employee Sep 1, 2010
Darrell Cook Individual Corporate Director Jan 1, 2010
Daren L Relph Individual Contracted Managing Employee Jun 14, 2010
Corporate OfficerChief Executive Officer Oct 1, 2013 100%
Donna Donald Individual Corporate Director Jan 1, 2008
Cynthia Shelley Individual Corporate Director Jan 1, 2021
Dewayne Watters Individual Corporate Director Jun 1, 2021
David McElvain Individual Corporate DirectorDirector Jan 15, 2024
Callie Mehrhoff Individual Corporate DirectorDirector Jun 16, 2025
Jill Tueth Individual Corporate Director Jan 1, 2010

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Lineville Medical ClinicLineville, IA, CCN 163435 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 13, 2010
Seymour Medical ClinicSeymour, IA, CCN 168541 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2010
South Central Iowa Medical ClinicCorydon, IA, CCN 168547 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2011
Humeston Family Medical ClinicHumeston, IA, CCN 168548 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2011

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 68

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 68

Affiliated clinicians 77

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 77

NPI Registry JSON

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469664000000",
    "number": "1174599468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 305",
            "city": "CORYDON",
            "state": "IA",
            "postal_code": "500600305",
            "telephone_number": "641-872-5341",
            "fax_number": "641-872-3116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 S EAST ST",
            "city": "CORYDON",
            "state": "IA",
            "postal_code": "500601860",
            "telephone_number": "641-872-2260",
            "fax_number": "641-872-3116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-27",
        "last_updated": "2016-07-28",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR, ADMINISTRATIVE SERVICES",
        "authorized_official_telephone_number": "641-872-5341"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corydon, IA

Sources for this page

Verify at the official NPI Registry.