NPIMap

Organization Active NPI

Hamilton County Public Hospital

Doing business as Van Diest Family Health Clinic

  • Rural Health Clinic/Center
  • Webster City, IA
National Provider Identifier
1174968697
Registry record updated Apr 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HAMILTON COUNTY PUBLIC HOSPITAL
Doing business as
Van Diest Family Health Clinic
Practice address
2350 Hospital Dr Ste a
Webster City, IA 50595-6600
Phone
(515) 832-7800
Fax
(515) 832-9498
NPI assigned
May 10, 2013
Last updated
Apr 9, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
HAMILTON COUNTY PUBLIC HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 9, 2021

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

Authorized official

Name
Alice Heinrichs
Title
Cfo
Phone
(515) 832-9400

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
MidwifeGroup: 193200000X MULTI-SPECIALTY GROUP 176B00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

2350 Hospital Dr Ste a
Webster City, IA 50595-6600

Mailing address

PO Box 430
Webster City, IA 50595-0430
Phone (515) 832-9400

Other names 1

  • Van Diest Family Health Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address himadmin@vdmc.cernerdirect.com Direct

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031216000775 IA Part B Supplier - Clinic/Group Practice 1254241565 Receives reassigned benefits from 78 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Webster City, IA; Stratford, IA; Jewell, IA; Fort Dodge, IA
O20170615001719 IA Part A Provider - Rural Health Clinic 1254241565 Practice locations: Webster City, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174968697. Details of each certification follow.

Rural health clinic certification: CCN 168589

Legal name
HAMILTON COUNTY PUBLIC HOSPITAL
Doing business as
VAN DIEST FAMILY HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 13, 2017
Last certification
Sep 13, 2017
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
2350 Hospital Dr
Ste a
Webster City, IA 50595-6600
Related CCNs
161361

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 7

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

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
16D2062767Van Diest Family Health Clinic2350 Hospital Drive, Ste a, Webster City, IA 50595Certificate of waiverJul 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Hamilton County Hospital13 organizations share this tax ID, including this one
Part of
Hamilton County Hospital

Other organizations with this tax ID 12

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

Locations

119 Avenue O W
Fort Dodge, IA 50501
Phone (515) 955-9200

2419 2nd Ave N
Fort Dodge, IA 50501
Phone (515) 576-2235

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Kyle Martin Heffernan Individual Corporate OfficerBoard Member Jan 28, 2020
Amy McDonough Individual Corporate OfficerCno Jan 3, 2018
W-2 Managing EmployeeCno Jan 3, 2018
Operational/Managerial ControlCno Jan 3, 2018
David Everson Individual Corporate Director May 26, 2020
Subhash Sahai Individual W-2 Managing EmployeeMedical Director Oct 1, 2016
Operational/Managerial ControlMedical Director Oct 1, 2016
Darcy Swon Individual Corporate Director Jul 28, 2015
Ashley N Allers Individual Corporate OfficerCfo Apr 1, 2022
W-2 Managing EmployeeCfo Jan 16, 2012
Operational/Managerial ControlCfo Apr 1, 2022
Kirk McCollough Individual Corporate Officer Jan 1, 2017
Corporate Director Jan 20, 2015
Mercy Health Network Inc Organization, West Des Moines, IA Non-profit Operational/Managerial Control Jul 1, 2010
Leigh Miller Individual W-2 Managing EmployeeClinic Director Sep 27, 2017
Operational/Managerial ControlClinic Director Sep 27, 2017
Carroll D Ose Individual Corporate Officer Jan 1, 2017
Corporate Director Jan 2, 2013
Lisa Ridge Individual Contracted Managing EmployeeCeo Oct 1, 2017
Corporate OfficerCeo Oct 1, 2017
Operational/Managerial ControlCeo Oct 1, 2017
Michelle Zahn Individual Corporate DirectorBoard Member Aug 23, 2022

Owners & managing parties with NPI records 2

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

Facilities with the same owner 98

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

View all 98

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1368144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617926400000",
    "number": "1174968697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 430",
            "city": "WEBSTER CITY",
            "state": "IA",
            "postal_code": "505950430",
            "telephone_number": "515-832-9400",
            "fax_number": "515-832-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 HOSPITAL DR STE A",
            "city": "WEBSTER CITY",
            "state": "IA",
            "postal_code": "505956600",
            "telephone_number": "515-832-7800",
            "fax_number": "515-832-9498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAMILTON COUNTY PUBLIC HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HAMILTON COUNTY PUBLIC HOSPITAL",
        "enumeration_date": "2013-05-10",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A",
        "authorized_official_last_name": "HEINRICHS",
        "authorized_official_first_name": "ALICE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "515-832-9400"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Midwife",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "himadmin@vdmc.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Van Diest Medical Center Medical Records",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2350 Hospital Drive",
            "city": "Webster City",
            "state": "IA",
            "country_code": "US",
            "postal_code": "505956600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Van Diest Family Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Webster City, IA

Sources for this page

Verify at the official NPI Registry.