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Shenandoah Medical Center

Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Shenandoah, IA

NPI 1346304524 · NPPES record last updated Jun 18, 2012

Key facts

NPI
1346304524
Entity type
Organization (NPI type 2)
Primary specialty
Medicare Defined Swing Bed Hospital Unit 275N00000X
License
730065H (IA)
Legal business name
SHENANDOAH MEDICAL CENTER
Practice address
300 Pershing Ave
Shenandoah, IA 51601-2355
Phone
(712) 246-1230
Fax
(712) 246-7357
NPI assigned
Dec 21, 2006
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 6

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

Owned or controlled facilities with NPI records 4

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

Other NPIs with the same Medicare PAC ID 6

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

Corporate family (same tax ID) 14

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

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

Facilities with the same owner 4

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

Practitioners 52

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

View all 52

Affiliated clinicians 4

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IA

Hospital certification: CCN 16Z366

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

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 Director
Board Member		 Jun 1, 2013
Matthew R Sells
Individual 		Corporate Officer
Ceo		 Aug 14, 2013
W-2 Managing Employee
Ceo		 Aug 14, 2013
Shenandoah Medical Center
Organization · Shenandoah, IA
Non-profit 		5% Or Greater Direct Ownership Interest Nov 1, 1979 100%

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

Medicare enrollment records

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

National Provider Directory

Tax ID family
Shenandoah Memorial Hospi (15 organizations share this tax ID)

Specialties & licenses

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

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

IdentifierTypeStateIssuer
0655696MedicaidIA

Other names

  • Shenandoah Memorial Hospital Doing business as

Other providers in Shenandoah, IA

All providers in Shenandoah, IA · Medicare Defined Swing Bed Hospital Unit in Iowa

Sources for this page

Verify at the official NPI Registry.