NPIMap

Organization Active NPI

Sumner Community Club

Doing business as Community Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Sumner, IA
National Provider Identifier
1366442295
Registry record updated Apr 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
SUMNER COMMUNITY CLUB
Doing business as
Community Memorial Hospital
Practice address
909 W 1St St
Sumner, IA 50674-1203
Phone
(563) 578-3275
Fax
(563) 578-3279
NPI assigned
Jul 21, 2005
Last updated
Apr 19, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SUMNER COMMUNITY CLUBAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 19, 2023

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

Authorized official

Name
Dawn Diane Everding, CFO
Title
Chief Administrator/Cfo
Phone
(563) 578-3275

Specialties & licenses 1

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

Addresses

Primary practice location

909 W 1St St
Sumner, IA 50674-1203

Mailing address

PO Box 148
Sumner, IA 50674-0148
Phone (563) 578-3275

Other names 1

  • Community 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
O20061215000095 IA Part A Provider - Critical Access Hospital 5890607691 Receives reassigned benefits from 33 practitioners
Practice locations: Sumner, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366442295. Details of each certification follow.

Hospital certification: CCN 16Z320

Legal name
SUMNER COMMUNITY CLUB
Doing business as
COMMUNITY MEMORIAL HOSPITAL MEDICAL CENTER
Organization structure
CorporationNon-profit
Enrollment address
909 W 1St St
Sumner, IA 50674-1203
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Community Memorial Hospital2 organizations share this tax ID, including this one
Part of
Community Memorial Hospital

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
United States Department of Agriculture Organization, Waverly, IA 5% Or Greater Mortgage Interest Dec 1, 2013 48.9%
Mariah Kay Nuss Individual Corporate DirectorBoard Member Mar 19, 2024
Andrew K Baker Individual Corporate DirectorBoard Member Mar 17, 2020
Sheila R Uhlenhake Individual W-2 Managing EmployeeManager of Analytics/Credentialing May 21, 2018
Paul Bahe Individual Corporate DirectorChair BD Directors Mar 18, 2025
Angela Leete Individual Corporate DirectorVice Chair BD Directors Mar 18, 2025
Allen Health Systems Inc Organization, Waterloo, IA Non-profit Operational/Managerial Control Jan 1, 2000
Elaine M Davis Individual Corporate DirectorSec/Treas BD Directors Mar 19, 2024
David Scott Individual Corporate DirectorMember of Board of Directors Mar 20, 2018
Daniel K Weltner Individual Corporate DirectorBoard Member Mar 17, 2026
Kevin R Holtz Individual Corporate DirectorBoard Member Mar 21, 2023
Tyler Steven Rau Individual Corporate OfficerBoard Member Mar 18, 2025
Kari L Kelly Individual Corporate DirectorBoard Member Mar 17, 2026
Michele M Anderson Individual Corporate DirectorBoard Member Mar 21, 2023
Sandra Christensen Individual Corporate OfficerBoard Member Mar 18, 2025
Dawn Daine Everding Individual Corporate OfficerPresident/Chief Financial Officer May 21, 2018
W-2 Managing EmployeePresident/Chief Financial Officer May 21, 2018

Facilities with the same owner 12

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 36

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 36

Affiliated clinicians 3

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": "1121904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681862400000",
    "number": "1366442295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 148",
            "city": "SUMNER",
            "state": "IA",
            "postal_code": "506740148",
            "telephone_number": "563-578-3275",
            "fax_number": "563-578-3279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 W 1ST ST",
            "city": "SUMNER",
            "state": "IA",
            "postal_code": "506741203",
            "telephone_number": "563-578-3275",
            "fax_number": "563-578-3279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMNER COMMUNITY CLUB",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUMNER COMMUNITY CLUB",
        "enumeration_date": "2005-07-21",
        "last_updated": "2023-04-19",
        "certification_date": "2021-12-03",
        "status": "A",
        "authorized_official_last_name": "EVERDING",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATOR/CFO",
        "authorized_official_telephone_number": "563-578-3275",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sumner, IA

Sources for this page

Verify at the official NPI Registry.