NPIMap

Organization Active NPI

Alegent Health Community Memorial Hospital of Missouri Valley, Iowa

Doing business as CHI Health Clinic Dunlap

  • Rural Health Clinic/Center
  • Dunlap, IA
National Provider Identifier
1316028020
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA
Doing business as
CHI Health Clinic Dunlap
Practice address
704 Iowa Ave
Dunlap, IA 51529-1336
Phone
(712) 643-2298
Fax
(712) 643-5630
NPI assigned
Oct 18, 2006
Last updated
Feb 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

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

Authorized official

Name
Evert Kuiper
Title
Ceo - CHI Health
Phone
(402) 343-4420

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

704 Iowa Ave
Dunlap, IA 51529-1336

Mailing address

704 Iowa Ave
Dunlap, IA 51529-1336
Phone (712) 643-2298

Other names 1

  • CHI Health Clinic Dunlap Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070530000405 IA Part A Provider - Rural Health Clinic 3678482130 Practice locations: Dunlap, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316028020. Details of each certification follow.

Rural health clinic certification: CCN 163476

Legal name
ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IOWA
Doing business as
CHI HEALTH CLINIC DUNLAP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 10, 1999
Last certification
Oct 27, 2022
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Dec 22, 1955 in IA
Enrollment address
704 Iowa Ave
Dunlap, IA 51529-1336
Related CCNs
161309

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

Other NPIs with the same Medicare PAC ID 7

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

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
16D0698726CHI Health Clinic Dunlap704 Iowa Avenue, Dunlap, IA 51529Certificate of waiverSep 29, 2026

National Provider Directory

National Provider Directory
Tax ID family
Alegent Health8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Member of 6

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 32

Organizations listed as members of this organization in the National Provider Directory.

View all 32

Locations

704 Iowa Ave
Dunlap, IA 51529
Phone (712) 643-2298

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
CHI Nebraska Organization, Omaha, NE Non-profit 5% Or Greater Direct Ownership Interest Aug 1, 2013 100%
Marvin O'Quinn Individual OtherCSH Home Office Administrator Aug 1, 2022
Nadine a Heimann Individual Corporate Director Jul 1, 2019
Maurita Soukup Individual Corporate Director Jul 1, 2017
Commonspirit Health Organization, Englewood, CO Non-profit 5% Or Greater Indirect Ownership Interest Aug 1, 2013 100%
David Jones Individual Operational/Managerial ControlPresdient Apr 17, 2021
William Barney Individual Corporate Director Jul 1, 2020
Kevin Fitzgerald Individual Corporate DirectorBod Jul 15, 2021
Suzanne L Hruza Individual Corporate DirectorBoard Member Sep 18, 2014
Nick O'Tool Individual Operational/Managerial ControlInterim Cfo - CHI Health Jan 7, 2023
Heather M Morgan Individual Corporate Director Jul 1, 2020
Kirtibala Gupta Individual Corporate DirectorBod Jul 15, 2021
Evert Kuiper Individual Corporate DirectorCeo CHI Health Jan 17, 2022
Operational/Managerial ControlCeo CHI Health Jan 17, 2022
John E Petersdorf Individual Corporate Director Jan 21, 2021
William Yates Individual Corporate Director Oct 1, 2015
Mardell Wilson Individual Corporate Director Oct 15, 2020
Kelly Bacon Individual Corporate DirectorBod Jul 15, 2021

Owners & managing parties with NPI records 3

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

Facilities with the same owner 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1316028020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 IOWA AVE",
            "city": "DUNLAP",
            "state": "IA",
            "postal_code": "515291336",
            "telephone_number": "712-643-2298",
            "fax_number": "712-643-5630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 IOWA AVE",
            "city": "DUNLAP",
            "state": "IA",
            "postal_code": "515291336",
            "telephone_number": "712-643-2298",
            "fax_number": "712-643-5630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "KUIPER",
        "authorized_official_first_name": "EVERT",
        "authorized_official_title_or_position": "CEO - CHI HEALTH",
        "authorized_official_telephone_number": "402-343-4420"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI Health Clinic Dunlap",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHI Health Clinic Dunlap",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dunlap, IA

Sources for this page

Verify at the official NPI Registry.