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Organization Active NPI

Shenandoah Medical Center

  • Critical Access Hospital
  • Shenandoah, IA
National Provider Identifier
1184621096
Registry record updated Jun 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
730065H Issued in IA
Legal business name
SHENANDOAH MEDICAL CENTER
Practice address
300 Pershing Ave
Shenandoah, IA 51601-2355
Phone
(712) 246-1230
Fax
(712) 246-7357
NPI assigned
Jul 7, 2005
Last updated
Jun 6, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2012

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

Authorized official

Name
Karen Cole
Title
Ceo
Phone
(712) 246-1230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 730065H IA Primary

Addresses

Primary practice location

300 Pershing Ave
Shenandoah, IA 51601-2355

Mailing address

300 Pershing Ave
Shenandoah, IA 51601-2355
Phone (712) 246-1230

Other identifiers 1

IdentifierTypeStateIssuer
0600924MedicaidIA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061104000390 IA Part A Provider - Critical Access Hospital 9436063237 Receives reassigned benefits from 34 practitioners
Practice locations: Shenandoah, IA
O20101018000540 IA Part A Provider - Rural Health Clinic 9436063237 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Shenandoah, IA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1184621096. Details of each certification follow.

Hospital certification: CCN 161366

Legal name
SHENANDOAH MEDICAL CENTER
Doing business as
SHENANDOAH MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2005
Last certification
Oct 21, 2021
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jun 16, 1978 in IA
Enrollment address
300 Pershing Ave
Shenandoah, IA 51601-2355
Other Hospital Practice Location

Rural health clinic certification: CCN 168549

Legal name
SHENANDOAH MEDICAL CENTER
Doing business as
SHENANDOAH PHYSICIANS CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 19, 2012
Last certification
Nov 8, 2018
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Mar 30, 1978 in IA
Enrollment address
1 Jack Foster Dr
Shenandoah, IA 51601-4586
Related CCNs
161366

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Shenandoah Medical CenterCCN 161366 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Roger D Jones Individual Corporate DirectorBoard Member Jun 1, 2013
Gregory M Ritchey Individual Corporate DirectorBoard Member Jan 1, 2006 100%
Matthew R Sells Individual Corporate OfficerCfo Apr 10, 2017 100%
W-2 Managing EmployeeCfo Aug 14, 2013
Corporate OfficerCeo May 1, 2017 100%
W-2 Managing EmployeeCeo Jul 28, 2014 100%
Timothy a Augustine Individual Corporate DirectorBoard Member Jan 1, 2010 100%
Alissa McGinnis Individual Corporate DirectorBoard Member Jan 1, 2013
Corporate DirectorBoard Member Jul 1, 2012 100%
Edward J Kloberdanz Individual Corporate DirectorBoard Member Mar 1, 2011
Corporate DirectorBoard Member Jul 1, 2012 100%
David R Lashier Individual Corporate DirectorBoard Member Jan 1, 2008
Mary Jo M Carrell Individual Corporate DirectorBoard Member Dec 11, 2006 100%
Jamie L Hossle Individual W-2 Managing EmployeeBusiness Office May 16, 2002 100%
Shenandoah Medical Center Organization, Shenandoah, IA Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 1985 100%
Operational/Managerial Control Oct 19, 2007
5% Or Greater Direct Ownership Interest Aug 31, 2010
Operational/Managerial Control Aug 31, 2010

Owners & managing parties with NPI records 6

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

  • Shenandoah Medical Center

    dba Shenandoah Memorial Hospital

    • Medicare Defined Swing Bed Hospital Unit
    • Shenandoah, IA
    • NPI 1346304524

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Shenandoah Medical Center

    dba Shenandoah Physicians Clinic

    • Rural Health Clinic/Center
    • Shenandoah, IA
    • NPI 1427300201

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Shenandoah Medical Center

    dba SMC Community Pharmacy

    • Community/Retail Pharmacy
    • Shenandoah, IA
    • NPI 1447937230

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Shenandoah Medical Center

    dba Shenandoah Physicians Clinic-Sidney

    • Rural Health Clinic/Center
    • Sidney, IA
    • NPI 1497150825

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Shenandoah Medical Center
    • Certified Registered Nurse Anesthetist
    • Shenandoah, IA
    • NPI 1497810972

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Shenandoah Medical Center
    • Rural Health Clinic/Center
    • Tabor, IA
    • NPI 1508487547

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Shenandoah Memorial HospitalShenandoah, IA, CCN 16Z366 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1979
Shenandoah Physicians ClinicShenandoah, IA, CCN 168549 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Aug 31, 2010
Aug 31, 2010
Shenandoah Physicians Clinic-SidneySidney, IA, CCN 168569 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2014
Shenandoah Physcians Clinic-TaborTabor, IA, CCN 168645 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 48

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 48

Affiliated clinicians 118

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

View all 118

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338940800000",
    "number": "1184621096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PERSHING AVE",
            "city": "SHENANDOAH",
            "state": "IA",
            "postal_code": "516012355",
            "telephone_number": "712-246-1230",
            "fax_number": "712-246-7357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PERSHING AVE",
            "city": "SHENANDOAH",
            "state": "IA",
            "postal_code": "516012355",
            "telephone_number": "712-246-1230",
            "fax_number": "712-246-7357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHENANDOAH MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2012-06-06",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-246-1230"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IA",
            "license": "730065H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0600924",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shenandoah, IA

Sources for this page

Verify at the official NPI Registry.