NPIMap

Organization Active NPI

Waverly Health Center

Doing business as Janesville Clinic

  • Rural Health Clinic/Center
  • Janesville, IA
National Provider Identifier
1184094534
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WAVERLY HEALTH CENTER
Doing business as
Janesville Clinic
Practice address
202 Wildcat Way
Janesville, IA 50647-1016
Phone
(319) 987-2361
NPI assigned
Sep 29, 2015
Last updated
Jun 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
WAVERLY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Authorized official

Name
Ms. Jodi M Geerts
Title
Ceo
Phone
(319) 352-4120

Specialties & licenses 1

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

Addresses

Primary practice location

202 Wildcat Way
Janesville, IA 50647-1016

Mailing address

312 9TH St SW
Waverly, IA 50677-2929
Phone (319) 352-4120

Other names 1

  • JANESVILLE CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180223001379 IA Part A Provider - Rural Health Clinic 8820996762 Practice locations: Janesville, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184094534. Details of each certification follow.

Rural health clinic certification: CCN 168611

Legal name
WAVERLY HEALTH CENTER
Doing business as
JANESVILLE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 19, 2018
Last certification
Jun 19, 2018
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
202 Wildcat Way
Janesville, IA 50647-1016
Related CCNs
161339

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
16D2104325Waverly Health Center202 Wildcat Way, Janesville, IA 50647Certificate of waiverMar 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Waverly ER Physician SV13 organizations share this tax ID, including this one
Part of
Waverly ER Physician SV

Other organizations with this tax ID 12

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

Locations

1922 5th Ave NW
Waverly, IA 50677
Phone (319) 352-4540

312 9th St SW
Ste 1000
Waverly, IA 50677
Phone (319) 483-4100

312 9th St SW
Ste 2100
Waverly, IA 50677
Phone (319) 483-4084

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Renu Bansal Individual W-2 Managing EmployeeMD; Sep 13, 2023
Operational/Managerial ControlMedical Director Sep 13, 2023
Ann Henninger Trax Individual Corporate Officer Jan 7, 2022
Corporate Director Jan 1, 2020
Jodi M Geerts Individual Corporate OfficerCeo Jan 18, 2023
W-2 Managing EmployeeCeo Jan 18, 2023
Operational/Managerial ControlCeo Jan 18, 2023
Philip S Jones Individual Corporate Officer Jan 7, 2022
Corporate Director Aug 31, 2021
David J Rathe Individual Corporate Director Jan 1, 2024
Laurie Everhardt Individual Corporate Director Jan 1, 2022
Nicole C Myers Individual W-2 Managing EmployeeAd;Chief Clinic Officer May 16, 2023
Operational/Managerial ControlChief Clinic Officer May 16, 2023

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 127

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 127

NPI Registry JSON

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

{
    "created_epoch": "1443484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1184094534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 9TH ST SW",
            "city": "WAVERLY",
            "state": "IA",
            "postal_code": "506772929",
            "telephone_number": "319-352-4120",
            "fax_number": "319-352-3992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 WILDCAT WAY",
            "city": "JANESVILLE",
            "state": "IA",
            "postal_code": "506471016",
            "telephone_number": "319-987-2361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAVERLY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAVERLY HEALTH CENTER",
        "enumeration_date": "2015-09-29",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "GEERTS",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "319-352-4120",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JANESVILLE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Janesville, IA

Sources for this page

Verify at the official NPI Registry.