NPIMap

Organization Active NPI

Humboldt County Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Humboldt, IA
National Provider Identifier
1235214420
Registry record updated Sep 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
460155H Issued in IA
Legal business name
HUMBOLDT COUNTY MEMORIAL HOSPITAL
Practice address
1000 15TH St N
Humboldt, IA 50548-1008
Phone
(515) 332-4200
Fax
(515) 332-4820
NPI assigned
Oct 26, 2006
Last updated
Sep 23, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
HUMBOLDT COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2016

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

Authorized official

Name
Ms. Michelle Sleiter
Title
Ceo
Phone
(515) 332-4200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 460155H IA Primary
Critical Access Hospital 282NC0060X 460155H IA

Addresses

Primary practice location

1000 15TH St N
Humboldt, IA 50548-1008

Mailing address

1000 15TH St N
Humboldt, IA 50548-1008
Phone (515) 332-4200

Other identifiers 2

IdentifierTypeStateIssuer
66152OtherIABLUE CROSS SNF
0655084MedicaidIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040813000626 IA Part A Provider - Critical Access Hospital 8921997867 Practice locations: Humboldt, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235214420. Details of each certification follow.

Hospital certification: CCN 16Z334

Legal name
HUMBOLDT COUNTY MEMORIAL HOSPITAL
Doing business as
HUMBOLDT COUNTY MEMORIAL HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
1000 15TH St N
Humboldt, IA 50548-1008
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Humboldt County Hospital7 organizations share this tax ID, including this one
Part of
Humboldt County Hospital

Other organizations with this tax ID 6

Organizations that report the same tax identification number 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
Natalie R Wergeland Individual Corporate Officer Jan 1, 2018
Corporate Director Aug 25, 2014
Trinity Health Systems, Inc Organization, Fort Dodge, IA Corporation, Non-profit Operational/Managerial Control Jan 1, 1994
Kevin W Bornhoft Individual Corporate Officer Jan 1, 2019
Corporate Director Nov 1, 2016
Ashley M Emick Individual Corporate Officer Jan 1, 2018
Corporate Director Apr 1, 2016
Pamela S Ray Individual Corporate Director Jan 2, 2021
Molly a Varangkounh Individual Corporate Director Jan 1, 2019
David L Boswell Individual Corporate Officer Jun 1, 2005
Corporate Director Jan 25, 1999
Cassidy R Long Individual Operational/Managerial ControlMedical Staff Director Jan 19, 2019
Timothy L McCartan Individual Corporate Director Jan 1, 2019
Michelle Sleiter Individual Contracted Managing EmployeeCeo Jan 1, 2015
Corporate OfficerCeo Jan 1, 2015
W-2 Managing EmployeeCeo Jan 1, 2015
Operational/Managerial ControlCeo Jan 1, 2015

Owners & managing parties with NPI records 1

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

Facilities with the same owner 27

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

View all 27

Practitioners & affiliated clinicians

Affiliated clinicians 6

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

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474588800000",
    "number": "1235214420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 15TH ST N",
            "city": "HUMBOLDT",
            "state": "IA",
            "postal_code": "505481008",
            "telephone_number": "515-332-4200",
            "fax_number": "515-332-4820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 15TH ST N",
            "city": "HUMBOLDT",
            "state": "IA",
            "postal_code": "505481008",
            "telephone_number": "515-332-4200",
            "fax_number": "515-332-4820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMBOLDT COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HUMBOLDT COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2006-10-26",
        "last_updated": "2016-09-23",
        "status": "A",
        "authorized_official_last_name": "SLEITER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "515-332-4200",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "IA",
            "license": "460155H",
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IA",
            "license": "460155H",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS SNF",
            "identifier": "66152",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0655084",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Humboldt, IA

Sources for this page

Verify at the official NPI Registry.