NPIMap

Organization Active NPI

Spencer Municipal Hospital

  • Nurse Practitioner
  • Sioux Rapids, IA
National Provider Identifier
1275723934
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
210037H Issued in IA
Legal business name
SPENCER MUNICIPAL HOSPITAL
Practice address
113 2ND St
Sioux Rapids, IA 50585-2057
Phone
(712) 283-2723
Fax
(712) 283-2751
NPI assigned
Jul 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Authorized official

Name
Brenda Tiefenthaler
Title
Chief Executive Officer
Phone
(712) 264-6111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X 210037H IA Primary

Addresses

Primary practice location

113 2ND St
Sioux Rapids, IA 50585-2057

Mailing address

1200 1St Ave E
Spencer, IA 51301-4330
Phone (712) 264-6111

Other identifiers 1

IdentifierTypeStateIssuer
1601120MedicaidIA

Other names 1

  • Nurse Practitioner Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040128000325 IA Part B Supplier - Clinic/Group Practice 4183533060 Receives reassigned benefits from 185 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sioux Rapids, IA; Spencer, IA; Milford, IA; Hartley, IA

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory
Tax ID family
Internal Medicine Clini14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1275723934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 1ST AVE E",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513014330",
            "telephone_number": "712-264-6111",
            "fax_number": "712-264-6464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 2ND ST",
            "city": "SIOUX RAPIDS",
            "state": "IA",
            "postal_code": "505852057",
            "telephone_number": "712-283-2723",
            "fax_number": "712-283-2751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPENCER MUNICIPAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-30",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A",
        "authorized_official_last_name": "TIEFENTHALER",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "712-264-6111"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "IA",
            "license": "210037H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1601120",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nurse Practitioner Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nurse Practitioner Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux Rapids, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.