Madison County Memorial Hospital
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Winterset, IA
NPI 1194880112 · NPPES record last updated Aug 22, 2016
Key facts
- NPI
- 1194880112
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- Legal business name
- MADISON COUNTY MEMORIAL HOSPITAL
- Practice address
- 300 W Hutchings St
Winterset, IA 50273-2104 - Phone
- (515) 462-2373
- Fax
- (515) 462-5213
- NPI assigned
- Dec 27, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- MADISON COUNTY MEMORIAL HOSPITAL
Authorized official
- Name
- Mrs. Marcia L Hendricks
- Title
- Ceo
- Phone
- (515) 462-2373
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 5
Related certifications (CCN) 1
Facilities with the same owner 98
Practitioners 71
-
Eric Asbe, DO
-
Clarice E. Blanchard, PA-C
-
Usha Chhatlani, M.D.
-
Amber C Dardanes, ARNP
-
Jennifer Elkin, D.O.
-
Jenna Evans, PA-C
-
Kathleen Nicole Evans, CRNA
-
Teri S Formanek, M.D.
-
Ann Gonnerman, ARNP
-
Paul A Grossmann, MD
-
Heidi Ha, ARNP
-
Laura F Hagen, ARNP
-
Virginia Hawthorne, ARNP
-
Amy E Hughes, DO
-
Nermin Imsirovic, ARNP
-
Bryon N. Johnson, D.O.
-
Emma Johnson, PA-C
-
Amy N. Kimball, DO
-
Scott Laurenzo, MD
-
Savannah Marker, DO
-
Matthew P McCormick, M.D.
-
Mark William Mintun, PA-C
-
Daniel Westcott Moyse, M.D.
-
Ambrose Munro, MD
Affiliated clinicians 4
-
Savannah Marker, DO
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Hospital certification: CCN 16Z326
- Legal name
- MADISON COUNTY MEMORIAL HOSPITAL
- Doing business as
- MADISON COUNTY HEALTH CARE SYSTEM
- Organization structure
- Other · Non-profit
- Enrollment address
- 300 W Hutchings St
Winterset, IA 50273-2104
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Jared McDonald |
Corporate Officer | Sep 26, 2019 | |
| Corporate Director | May 28, 2015 | ||
| Sarah C. Nigg |
Corporate Director | May 9, 2024 | |
| Brian K Gibson |
Corporate Officer | Dec 1, 2022 | |
| Corporate Director | Dec 14, 2021 | ||
| Mercy Health Network Inc |
Operational/Managerial Control | Nov 1, 2012 | |
| Julie R Plant |
Corporate Director | Jan 22, 2026 | |
| Jacque Mohs |
Corporate Officer | Jan 1, 2021 | |
| Corporate Director | Jul 23, 2015 | ||
| Sharon Carlson |
Corporate Director | Jan 26, 2017 | |
| Audra C Ford |
Corporate Officer |
Sep 2, 2024 | |
| W-2 Managing Employee |
Sep 2, 2024 | ||
| Operational/Managerial Control |
Sep 2, 2024 | ||
| Gary R Van Dyke |
Corporate Director | Jan 1, 2025 | |
| Marcia L. Hendricks |
Contracted Managing Employee |
Sep 8, 2003 | |
| Corporate Officer |
Jun 23, 2016 | ||
| Operational/Managerial Control |
Sep 8, 2003 | ||
| Kevin V Deregnier |
W-2 Managing Employee |
Nov 14, 2025 | |
| Operational/Managerial Control |
Nov 14, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110928000095 | IA | Part a Provider - Critical Access Hospital | 6002727179 | Practice locations: Winterset, IA |
National Provider Directory
- Tax ID family
- Madison County Memorial
- Part of
- Madison County Memorial
Locations
901 S 4th Ave
Ste A
Winterset, IA 50273
Phone 5154622373605
300 W Hutchings St
#100
Winterset, IA 50273
Phone (515) 462-2373
300 W Hutchings St
Ste 100110
Winterset, IA 50273
Phone (515) 462-2950
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | Yes |
Addresses
Primary practice location
300 W Hutchings St
Winterset, IA 50273-2104
Mailing address
300 W Hutchings St
Winterset, IA 50273-2104
Phone (515) 462-2373
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 66052 | Other | IA | BCBS |
| 0655654 | Medicaid | IA |
Other names
- Madison County Health Care System
Other providers in Winterset, IA
- Madison County Elderly Services
- Madison County Health Care System
- Madison County Medical Assoc, PC
- Madison County Medical Equipment Inc
- Madison County Memorial Hospital
- Madison County Memorial Hospital
- Madison County Memorial Hospital
- Madison County Memorial Hospital
- Madison County Memorial Hospital
- Madison County Memorial Hospital
All providers in Winterset, IA · Medicare Defined Swing Bed Hospital Unit in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2016. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.