NPIMap

Organization Active NPI

Stewart Memorial Community Hospital

Doing business as Stewart Memorial Clinic Lake City

  • Rural Health Clinic/Center
  • Lake City, IA
National Provider Identifier
1285652909
Registry record updated Jun 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
STEWART MEMORIAL COMMUNITY HOSPITAL
Doing business as
Stewart Memorial Clinic Lake City
Practice address
1351 W Main St
Lake City, IA 51449-1585
Phone
(712) 464-7907
Fax
(712) 464-7412
NPI assigned
Jul 18, 2006
Last updated
Jun 17, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
STEWART MEMORIAL COMMUNITY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 17, 2026

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

Authorized official

Name
James L Henkenius
Title
Cfo
Phone
(712) 464-4200

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU
Family Medicine Physician 207Q00000X NU
Rural Health Clinic/Center 261QR1300X IA Primary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU

Addresses

Primary practice location

1351 W Main St
Lake City, IA 51449-1585

Mailing address

1301 W Main St
Lake City, IA 51449-1585
Phone (712) 464-3171

Other names 1

  • Stewart Memorial Clinic Lake City Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031107000249 IA Part B Supplier - Clinic/Group Practice 4486563707 Receives reassigned benefits from 48 practitioners
7 other NPIs on this enrollment
Practice locations: Lake City, IA
O20061201000249 IA Part A Provider - Rural Health Clinic 4486563707 Practice locations: Lake City, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285652909. Details of each certification follow.

Rural health clinic certification: CCN 168522

Legal name
STEWART MEMORIAL COMMUNITY HOSPITAL
Doing business as
STEWART MEMORIAL CLINIC LAKE CITY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 22, 2007
Last certification
Sep 2, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
May 29, 1958 in IA
Enrollment address
1351 W Main St
Lake City, IA 51449-1585
Related CCNs
161350

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Stewart Mem Community5 organizations share this tax ID, including this one
Part of
Stewart Mem Community

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Ann Lynn Lengeling Individual W-2 Managing EmployeeCno Aug 4, 2020
Operational/Managerial ControlCno Aug 4, 2020
James L Henkenius Individual Corporate OfficerCfo Nov 26, 2013
W-2 Managing EmployeeCfo Sep 1, 1997
Operational/Managerial ControlCfo Sep 1, 1997
Trinity Health Systems, Inc Organization, Fort Dodge, IA Corporation, Non-profit Operational/Managerial Control Aug 1, 2012
Jennifer L Lane Individual Corporate Director Apr 26, 2022
Theresa J Hildreth Individual Corporate Officer Apr 23, 2019
Corporate Director May 24, 2016
Stacy D Corey Individual Corporate Officer Apr 1, 2024
Corporate Director Apr 26, 2022
Charles E Schmitt Individual Corporate Director Oct 24, 2023
Scott a Nesbitt Individual Corporate Officer Apr 1, 2023
Corporate Director Apr 1, 2012
Jordan a Lietz Individual Corporate Officer Apr 26, 2022
Corporate Director Apr 28, 2018
Mary M Lauver Individual Corporate Director Apr 26, 2022
Linn Block Individual Contracted Managing EmployeeCeo Dec 11, 2023
Corporate OfficerCeo Dec 11, 2023
Operational/Managerial ControlCeo Dec 11, 2023
Derek L Duncan Individual Corporate Director Apr 1, 2024
W-2 Managing EmployeeMD; Jan 1, 2018
Operational/Managerial ControlMedical Director Jan 1, 2018

Owners & managing parties with NPI records 1

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

  • Derek L Duncan, DO
    • Family Medicine Physician
    • Lake City, IA
    • NPI 1487764957

    Corporate Director, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

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

Practitioners 52

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 52

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781654400000",
    "number": "1285652909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 W MAIN ST",
            "city": "LAKE CITY",
            "state": "IA",
            "postal_code": "514491585",
            "telephone_number": "712-464-3171",
            "fax_number": "712-464-3269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 W MAIN ST",
            "city": "LAKE CITY",
            "state": "IA",
            "postal_code": "514491585",
            "telephone_number": "712-464-7907",
            "fax_number": "712-464-7412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEWART MEMORIAL COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STEWART MEMORIAL COMMUNITY HOSPITAL",
        "enumeration_date": "2006-07-18",
        "last_updated": "2026-06-17",
        "certification_date": "2026-06-17",
        "status": "A",
        "authorized_official_last_name": "HENKENIUS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "712-464-4200"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IA",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stewart Memorial Clinic Lake City",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stewart Memorial Clinic Lake City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake City, IA

Sources for this page

Verify at the official NPI Registry.