NPIMap

Organization Active NPI

Community Health Center of Fort Dodge, Inc.

Doing business as Community Health Center of Spencer

  • Federally Qualified Health Center (FQHC)
  • Spencer, IA
National Provider Identifier
1376351841
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTER OF FORT DODGE, INC.
Doing business as
Community Health Center of Spencer
Practice address
223 W 7TH St
Spencer, IA 51301-3704
Phone
(515) 576-6500
Fax
(515) 576-1951
NPI assigned
Dec 30, 2024
Last updated
Dec 30, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY HEALTH CENTER OF FORT DODGE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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

Authorized official

Name
Renae Irene Elizabeth Kruckenberg
Title
Ceo
Phone
(515) 576-6500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

223 W 7TH St
Spencer, IA 51301-3704

Mailing address

126 N 10TH St
Fort Dodge, IA 50501-3915
Phone (515) 576-6500

Other names 1

  • Community Health Center of Spencer Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070104000109 IA Part B Supplier - Clinic/Group Practice 1557378627 Receives reassigned benefits from 33 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Spencer, IA; Mason City, IA; Fort Dodge, IA; Dayton, IA; Eagle Grove, IA; Clarion, IA
O20250131001698 IA Part A Provider - Federally Qualified Health Center (FQHC) 1557378627 Practice locations: Spencer, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376351841. Details of each certification follow.

Federally qualified health center certification: CCN 161040

Legal name
COMMUNITY HEALTH CENTER OF FORT DODGE INC
Doing business as
COMMUNITY HEALTH CENTER OF SPENCER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 24, 2025
Last certification
Jan 24, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
223 W 7TH St
Spencer, IA 51301-3704

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 5

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

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
16D2316523Community Health Center of Spencer223 W 7TH St, Spencer, IA 51301Provider-performed microscopyJan 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center Inc5 organizations share this tax ID, including this one
Part of
Community Health Center Inc

Other organizations with this tax ID 4

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

Locations

404 N Federal Ave
Mason City, IA 50401
Phone (641) 450-0601

223 W 7th St
Spencer, IA 51301
Phone (515) 576-6500

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Community Health Center of Fort Dodge Inc Organization, Fort Dodge, IA Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Jan 1, 2025 5%
Operational/Managerial Control Jan 1, 2025 5%
Renae Kruckenberg Individual 5% Or Greater Direct Ownership InterestCeo Jan 1, 2025 5%
Corporate DirectorCeo Jan 1, 2025 100%
W-2 Managing EmployeeCeo Jan 1, 2025 5%
David Bowser Individual General Partnership InterestTresasurer Jan 1, 2025 5%
Dale Harlow Individual General Partnership InterestVice President Jan 1, 2025 5%
Kittie Webster Individual General Partnership InterestPresident Jan 1, 2025 5%

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 1

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

FacilityTypeRoleSince
Community Health Center of DaytonDayton, IA, CCN 161885 Federally qualified health center 5% Or Greater Direct Ownership Interest (5%)
5% Or Greater Security Interest (5%)
Operational/Managerial Control (5%)		 Jul 1, 2014
Jul 1, 2014
Jul 1, 2014

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1735516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735516800000",
    "number": "1376351841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 N 10TH ST",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505013915",
            "telephone_number": "515-576-6500",
            "fax_number": "515-576-1951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 W 7TH ST",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513013704",
            "telephone_number": "515-576-6500",
            "fax_number": "515-576-1951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER OF FORT DODGE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY HEALTH CENTER OF FORT DODGE, INC.",
        "enumeration_date": "2024-12-30",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A",
        "authorized_official_last_name": "KRUCKENBERG",
        "authorized_official_first_name": "RENAE",
        "authorized_official_middle_name": "IRENE ELIZABETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "515-576-6500"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Center of Spencer",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spencer, IA

Sources for this page

Verify at the official NPI Registry.