NPIMap

Organization Active NPI

People's Memorial Hospital

Doing business as BCHC Family Medicine - Jesup

  • Rural Health Clinic/Center
  • Jesup, IA
National Provider Identifier
1386201333
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PEOPLE'S MEMORIAL HOSPITAL
Doing business as
BCHC Family Medicine - Jesup
Practice address
211 South Street West
Jesup, IA 50648
Phone
(319) 332-0999
NPI assigned
May 24, 2019
Last updated
Mar 14, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
PEOPLE'S MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 14, 2022

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

Authorized official

Name
Wade E Weis
Title
Ceo
Phone
(319) 332-0999

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

211 South Street West
Jesup, IA 50648

Mailing address

1600 1St St E
Independence, IA 50644-3155
Phone (319) 332-0999

Other names 1

  • BCHC FAMILY MEDICINE - JESUP Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031118000161 IA Part B Supplier - Clinic/Group Practice 9931010790 Receives reassigned benefits from 99 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Independence, IA; Jesup, IA; Oelwein, IA
O20200218002513 IA Part A Provider - Rural Health Clinic 9931010790 Practice locations: Jesup, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386201333. Details of each certification follow.

Rural health clinic certification: CCN 168640

Legal name
PEOPLES MEMORIAL HOSPITAL
Doing business as
BCHC FAMILY MEDICINE - JESUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 6, 2020
Last certification
Aug 23, 2023
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
211 South St W
Jesup, IA 50648-9363
Related CCNs
161335

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).

Other NPIs on the same Medicare enrollment 3

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
16D2176224BCHC Family Medicine - Jesup211 South Street West, Jesup, IA 50648Certificate of waiverDec 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Peoples Memorial Hosp E8 organizations share this tax ID, including this one
Part of
Peoples Memorial Hosp E

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Anne Edgington McMillan Individual Corporate Officer Jan 1, 2013
Corporate Director Jan 1, 2013
Cynthia S Horn Individual Corporate DirectorTrustee Feb 25, 2026
David L Fahey Individual W-2 Managing EmployeeMedical Director Jan 13, 2020
Operational/Managerial ControlMedial Director Jan 13, 2020
Vera Cummings Individual W-2 Managing Employee Jan 4, 2019
Donald L Bloes Individual Corporate Officer Jul 28, 2015
Corporate Director Jul 28, 2015
Robin Robinson Individual Corporate Officer Jan 1, 2013
Corporate Director Jan 1, 2013
Dennis G Donlea Individual Corporate Officer Dec 4, 2017
Corporate Director Jul 26, 2016
Wade Weis Individual Corporate OfficerCeo Feb 23, 2022
Corporate DirectorCeo Feb 23, 2022
W-2 Managing EmployeeCeo Feb 23, 2022
Anthony M. Fortmann Individual Corporate OfficerCfo Aug 26, 2024
Corporate DirectorCfo Aug 26, 2024
W-2 Managing EmployeeCfo Aug 26, 2024
Amy Vanscoyoc Individual Corporate DirectorClinic Director May 7, 2007
W-2 Managing Employee May 7, 2007
Operational/Managerial Control May 7, 2007

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1558656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1386201333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 1ST ST E",
            "city": "INDEPENDENCE",
            "state": "IA",
            "postal_code": "506443155",
            "telephone_number": "319-332-0999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 SOUTH STREET WEST",
            "city": "JESUP",
            "state": "IA",
            "postal_code": "50648",
            "telephone_number": "319-332-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEOPLE'S MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEOPLE'S MEMORIAL HOSPITAL",
        "enumeration_date": "2019-05-24",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "WEIS",
        "authorized_official_first_name": "WADE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "319-332-0999"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BCHC FAMILY MEDICINE - JESUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jesup, IA

Sources for this page

Verify at the official NPI Registry.