NPIMap

Organization Active NPI

Clarinda Regional Health Center

  • Medicare Defined Swing Bed Hospital Unit
  • Clarinda, IA
National Provider Identifier
1255489647
Registry record updated May 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
CLARINDA REGIONAL HEALTH CENTER
Practice address
220 Essie Davison Dr
Clarinda, IA 51632-2915
Phone
(712) 542-2176
NPI assigned
Jan 8, 2007
Last updated
May 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2014

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

Authorized official

Name
Elaine Otte
Title
Coo
Phone
(712) 542-2176

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

220 Essie Davison Dr
Clarinda, IA 51632-2915

Mailing address

PO Box 217
Clarinda, IA 51632-2625
Phone (712) 542-2176

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070131000204 IA Part A Provider - Critical Access Hospital 4587573993 Receives reassigned benefits from 17 practitioners
Practice locations: Clarinda, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255489647. Details of each certification follow.

Hospital certification: CCN 16Z352

Legal name
CLARINDA REGIONAL HEALTH CENTER
Doing business as
CLARINDA REGIONAL HEALTH CENTER
Organization structure
GovernmentNon-profit
Incorporated
in IA
Enrollment address
220 Essie Davison Dr
Clarinda, IA 51632-2915
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Villisca Family Health Center11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

220 Essie Davison Dr
Clarinda, IA 51632
Phone (712) 542-8330

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Bryan L Whipp Individual Corporate DirectorBoard Member Jan 22, 2018
Dale D Fulk Individual Corporate DirectorBoard Member Jan 1, 2018
City of Clarinda Organization, Clarinda, IA 5% Or Greater Direct Ownership Interest Nov 14, 2007 100%
Robert J Marsh Individual Corporate DirectorBoard Member Jan 1, 2018
Tyler Hill Individual Corporate OfficerCno Dec 5, 2018 100%
W-2 Managing EmployeeCno Dec 5, 2018 100%
Katharine Boysen Individual Corporate DirectorBoard Member Jan 1, 2018
Charles W. Nordyke Individual Corporate OfficerCeo/Administrator Jun 29, 2018 100%
W-2 Managing EmployeeCeo/Administrator Feb 1, 2021 100%
Jeffrey Clark Individual Corporate DirectorBoard Member Dec 17, 2019

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 17

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 17

Affiliated clinicians 11

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": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400630400000",
    "number": "1255489647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 217",
            "city": "CLARINDA",
            "state": "IA",
            "postal_code": "516322625",
            "telephone_number": "712-542-2176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 ESSIE DAVISON DR",
            "city": "CLARINDA",
            "state": "IA",
            "postal_code": "516322915",
            "telephone_number": "712-542-2176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARINDA REGIONAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2014-05-21",
        "status": "A",
        "authorized_official_last_name": "OTTE",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "712-542-2176"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarinda, IA

Sources for this page

Verify at the official NPI Registry.