Alegent Health Community Memorial Hospital of Missouri Valley Iowa
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Missouri Valley, IA
NPI 1235237447 · NPPES record last updated Jan 20, 2022
Key facts
- NPI
- 1235237447
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- 430030H (IA)
- Legal business name
- ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IOWA
- Practice address
- 631 N 8TH St
Missouri Valley, IA 51555-1102 - Phone
- (712) 642-2784
- NPI assigned
- Sep 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Evert Kuiper
- Title
- Ceo - CHI Health
- Phone
- (402) 343-4420
Owners & managing parties with NPI records 3
-
Kirtibala Gupta, M.D
-
Suzanne L Hruza, MD
-
Heather M Morgan, M.D.
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 7
Related certifications (CCN) 1
Facilities with the same owner 38
Practitioners 28
-
Juanita Daisy Alvarez-Hall, MSN, FNP-C
-
Nathaniel Vaughn Alvis, D.O.
-
Dawn Michelle Bonham, ARNP
-
Sydney Irene Bryen, PA-C
-
Taylor M Ehlert, NP
-
Melissa Jo Frazier, DNP ARNP
-
Jane E Gambs, PA-C
-
Carrie Lynn Grady, M.D.
-
Jennifer Hall, A.R.N.P.
-
Alyssa K Hamik, PA-C
-
Brandon Mitchell Jerred, MA, MFT
-
Melissa Kay Klutts, ARNP
-
David A Minnick, MD
-
Sharon Louise Pitt, APRN, FNP-C
-
Tracy A Schoening, ARNP
-
James R Scott, D.O.
-
Ahmad Alchommali, MD
-
Peter F Fowle, LCSW
-
Daniel Edward Hatz, M.D.
-
Amy Jackson, A.R.N.P.
-
Christopher Jankovich, P.A.-C.
-
Pamela Lacey Leuschen, APRN, FNP-C
Affiliated clinicians 2
-
Shagufta Hayat, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Hospital certification: CCN 16Z309
- Legal name
- ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IOWA
- Doing business as
- CHI HEALTH MISSOURI VALLEY
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 22, 1955 in IA
- Enrollment address
- 631 N 8TH St
Missouri Valley, IA 51555-1102
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| CHI Nebraska |
5% Or Greater Direct Ownership Interest | Aug 1, 2013 | 100% |
| Marvin O'Quinn |
Other |
Aug 1, 2022 | |
| Nadine a Heimann |
Corporate Director | Jul 1, 2019 | |
| Maurita Soukup |
Corporate Director | Jul 1, 2017 | |
| Commonspirit Health |
5% Or Greater Indirect Ownership Interest | Aug 1, 2013 | 100% |
| David Jones |
Operational/Managerial Control |
Apr 17, 2021 | |
| William Barney |
Corporate Director | Jul 1, 2020 | |
| Kevin Fitzgerald |
Corporate Director |
Jul 15, 2021 | |
| Suzanne L Hruza |
Corporate Director |
Sep 18, 2014 | |
| Nick O'Tool |
Operational/Managerial Control |
Jan 7, 2023 | |
| Heather M Morgan |
Corporate Director | Jul 1, 2020 | |
| Kirtibala Gupta |
Corporate Director |
Jul 15, 2021 | |
| Evert Kuiper |
Corporate Director |
Jan 17, 2022 | |
| Operational/Managerial Control |
Jan 17, 2022 | ||
| John E Petersdorf |
Corporate Director | Jan 21, 2021 | |
| William Yates |
Corporate Director | Oct 1, 2015 | |
| Mardell Wilson |
Corporate Director | Oct 15, 2020 | |
| Kelly Bacon |
Corporate Director |
Jul 15, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110608000066 | IA | Part a Provider - Critical Access Hospital | 3678482130 | Practice locations: Missouri Valley, IA |
National Provider Directory
- Tax ID family
- Alegent Health Comm Mem
Locations
631 N 8th St
Mo Valley, IA 51555
Phone (712) 642-2045
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 430030H | IA | Yes |
Addresses
Primary practice location
631 N 8TH St
Missouri Valley, IA 51555-1102
Mailing address
PO Box 310336
Des Moines, IA 50331-0336
Other names
- CHI Health Missouri Valley
Other providers in Missouri Valley, IA
- Adult & Pediatric Urology PC
- Alegent Health Community Memorial Hospital of Missouri Valley Iowa
- Alegent Health Community Memorial Hospital of Missouri Valley Iowa
- Alegent Health Community Memorial Hospital of Missouri Valley, Iowa
- Alegent Health Community Memorial Hospital of Missouri Valley, Iowa
- Alegent Health Community Memorial Hospital of Missouri Valley, Iowa
- Ap Behavioral Health LLC
All providers in Missouri Valley, 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 Jan 20, 2022. 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.