NPIMap

Organization Active NPI

Ellsworth Municipal Hospital

Doing business as Ellsworth Family Medicine-Hubbard

  • Primary Care Clinic/Center
  • Hubbard, IA
National Provider Identifier
1306029053
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
18633 Issued in IA
Legal business name
ELLSWORTH MUNICIPAL HOSPITAL
Doing business as
Ellsworth Family Medicine-Hubbard
Practice address
324 East Maple Street
Hubbard, IA 50122-0487
Phone
(641) 648-3202
Fax
(641) 648-3203
NPI assigned
Dec 17, 2007
Last updated
Dec 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

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

Authorized official

Name
Mr. Michael White
Title
Ceo
Phone
(641) 648-4631

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 18633 IA Primary

Addresses

Primary practice location

324 East Maple Street
Hubbard, IA 50122-0487

Mailing address

324 East Maple Street
PO Box 487
Hubbard, IA 50122-0487
Phone (641) 648-3202

Other identifiers 3

IdentifierTypeStateIssuer
I15574OtherIAMEDICARE GROUP
I15576OtherIAMEDICARE
2129163MedicaidIA

Other names 1

  • ELLSWORTH FAMILY MEDICINE-HUBBARD Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address HIM@elmhn.cernerdirect.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040212000269 IA Part B Supplier - Clinic/Group Practice 2668366311 Receives reassigned benefits from 39 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ackley, IA; Iowa Falls, IA; Zearing, IA

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

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": "1197849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1306029053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 EAST MAPLE STREET",
            "address_2": "PO BOX 487",
            "city": "HUBBARD",
            "state": "IA",
            "postal_code": "501220487",
            "telephone_number": "641-648-3202",
            "fax_number": "641-648-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 EAST MAPLE STREET",
            "city": "HUBBARD",
            "state": "IA",
            "postal_code": "501220487",
            "telephone_number": "641-648-3202",
            "fax_number": "641-648-3203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLSWORTH MUNICIPAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-17",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "641-648-4631",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IA",
            "license": "18633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "I15574",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "I15576",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2129163",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "HIM@elmhn.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Hansen Family Hospital Direct Email Address",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "920 S Oak St",
            "city": "Iowa Falls",
            "state": "IA",
            "country_code": "US",
            "postal_code": "501269506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "ELLSWORTH FAMILY MEDICINE-HUBBARD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ELLSWORTH FAMILY MEDICINE-HUBBARD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hubbard, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; 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.