NPIMap

Organization Active NPI

Greater Regional Medical Center

Doing business as Corning Medical Clinic

  • Rural Health Clinic/Center
  • Corning, IA
National Provider Identifier
1275048977
Registry record updated Feb 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GREATER REGIONAL MEDICAL CENTER
Doing business as
Corning Medical Clinic
Practice address
700 Davis Ave
Corning, IA 50841-1419
Phone
(641) 322-4431
Fax
(641) 322-5052
NPI assigned
Dec 5, 2017
Last updated
Feb 25, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2020

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

Authorized official

Name
Matthew L McCutchan
Title
Cfo
Phone
(641) 782-3899

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

700 Davis Ave
Corning, IA 50841-1419

Mailing address

1700 W Townline St
Creston, IA 50801-1054
Phone (641) 782-7091

Other names 1

  • Corning Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040205000926 IA Part B Supplier - Clinic/Group Practice 9234041013 Receives reassigned benefits from 82 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Creston, IA; Osceola, IA; Greenfield, IA
O20190226000149 IA Part A Provider - Rural Health Clinic 9234041013 Practice locations: Corning, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275048977. Details of each certification follow.

Rural health clinic certification: CCN 168636

Legal name
GREATER REGIONAL MEDICAL CENTER
Doing business as
CORNING MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 8, 2020
Last certification
Apr 8, 2020
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
700 Davis Ave
Corning, IA 50841-1419
Related CCNs
161365

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).

Other NPIs on the same Medicare enrollment 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2156414Corning Medical Clinic700 Davis Avenue, Corning, IA 50841Certificate of waiverOct 16, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Sharon Kay McKie Individual Corporate Officer Jan 1, 2011
Corporate Director Jan 1, 1997
Lucas E Neitzel Individual W-2 Managing EmployeeAd;Clinic Director Mar 6, 2017
Operational/Managerial ControlClinic Director Mar 6, 2017
Central Iowa Hospital Corporation Organization, Des Moines, IA Corporation, Non-profit Operational/Managerial Control Jul 1, 2017
Kenneth Dawson Stults Individual Corporate Officer Jan 27, 2025
Corporate Director Jan 26, 2015
Adrianna Cleopatra Shuey Individual W-2 Managing EmployeeMD; Jun 1, 2021
Operational/Managerial ControlMedical Director Jun 1, 2021
Thomas L Lesan Individual Corporate Officer Jan 23, 2023
Corporate Director Mar 11, 2010
Matthew L McCutchan Individual Corporate OfficerCfo Nov 25, 2013
W-2 Managing EmployeeCfo Mar 29, 2009
Operational/Managerial ControlCfo Mar 29, 2009
Julie a Lanning Individual Corporate Director Aug 26, 2019
R Jack Davis Individual Corporate Officer Jan 23, 2012
Corporate Director Jan 1, 1995
Karen J Krogstad Individual W-2 Managing EmployeeMD; Jun 1, 2021
Operational/Managerial ControlMedical Director Jun 1, 2021
Monte E. Neitzel Individual Corporate OfficerCeo Nov 25, 2013
W-2 Managing EmployeeCeo Aug 4, 2003
Operational/Managerial ControlCeo Aug 4, 2003

Owners & managing parties with NPI records 9

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

Facilities with the same owner 22

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

View all 22

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1512432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582588800000",
    "number": "1275048977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 W TOWNLINE ST",
            "city": "CRESTON",
            "state": "IA",
            "postal_code": "508011054",
            "telephone_number": "641-782-7091",
            "fax_number": "641-782-3830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 DAVIS AVE",
            "city": "CORNING",
            "state": "IA",
            "postal_code": "508411419",
            "telephone_number": "641-322-4431",
            "fax_number": "641-322-5052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-05",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A",
        "authorized_official_last_name": "MCCUTCHAN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "641-782-3899"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corning Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Corning, IA

Sources for this page

Verify at the official NPI Registry.