NPIMap

Organization Active NPI

Shenandoah Medical Center

Doing business as Shenandoah Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Shenandoah, IA
National Provider Identifier
1346304524
Registry record updated Jun 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
730065H Issued in IA
Legal business name
SHENANDOAH MEDICAL CENTER
Doing business as
Shenandoah Memorial Hospital
Practice address
300 Pershing Ave
Shenandoah, IA 51601-2355
Phone
(712) 246-1230
Fax
(712) 246-7357
NPI assigned
Dec 21, 2006
Last updated
Jun 18, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2012

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

Authorized official

Name
Karen Cole
Title
Ceo
Phone
(712) 246-1230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 730065H IA Primary

Addresses

Primary practice location

300 Pershing Ave
Shenandoah, IA 51601-2355

Mailing address

300 Pershing Ave
Shenandoah, IA 51601-2355
Phone (712) 246-1230

Other identifiers 1

IdentifierTypeStateIssuer
0655696MedicaidIA

Other names 1

  • Shenandoah Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070129000561 IA Part A Provider - Critical Access Hospital 9436063237 Practice locations: Shenandoah, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346304524. Details of each certification follow.

Hospital certification: CCN 16Z366

Legal name
SHENANDOAH MEDICAL CENTER
Doing business as
SHENANDOAH MEMORIAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Jun 6, 1978 in IA
Enrollment address
300 Pershing Ave
Shenandoah, IA 51601-2355

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

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Shenandoah Memorial Hos15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Roger D Jones Individual Corporate DirectorBoard Member Jun 1, 2013
Matthew R Sells Individual Corporate OfficerCeo Aug 14, 2013
W-2 Managing EmployeeCeo Aug 14, 2013
Shenandoah Medical Center Organization, Shenandoah, IA Non-profit 5% Or Greater Direct Ownership Interest Nov 1, 1979 100%

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Shenandoah Memorial HospitalShenandoah, IA, CCN 161366 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 1, 1985
Oct 19, 2007
Shenandoah Physicians ClinicShenandoah, IA, CCN 168549 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Aug 31, 2010
Aug 31, 2010
Shenandoah Physicians Clinic-SidneySidney, IA, CCN 168569 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2014
Shenandoah Physcians Clinic-TaborTabor, IA, CCN 168645 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339977600000",
    "number": "1346304524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PERSHING AVE",
            "city": "SHENANDOAH",
            "state": "IA",
            "postal_code": "516012355",
            "telephone_number": "712-246-1230",
            "fax_number": "712-246-7357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PERSHING AVE",
            "city": "SHENANDOAH",
            "state": "IA",
            "postal_code": "516012355",
            "telephone_number": "712-246-1230",
            "fax_number": "712-246-7357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHENANDOAH MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2012-06-18",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-246-1230"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "IA",
            "license": "730065H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0655696",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shenandoah Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shenandoah, IA

Sources for this page

Verify at the official NPI Registry.