Countryside Medical Clinic, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

COUNTRYSIDE MEDICAL CLINIC, LLC

Practice address

909 E 2ND Ave Ste G
Indianola, IA 50125-2892

Phone

(712) 370-3910

Fax

(888) 573-6009

NPI assigned

Feb 2, 2016

Last updated

Aug 22, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kimberly Lynn Rines, ARNP, MSN, RNNPI 1932455052

Title

Owner/NP

Phone

(712) 370-3910

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Locations

Practitioners 1

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.

• Kimberly Lynn Rines, ARNP, MSN, RN

  • Nurse Practitioner
  • Indianola, IA
  • NPI 1932455052
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1454371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787356800000",
    "number": "1396103685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 E 2ND AVE STE G",
            "city": "INDIANOLA",
            "state": "IA",
            "postal_code": "501252892",
            "telephone_number": "712-370-3910",
            "fax_number": "888-573-6009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 E 2ND AVE STE G",
            "city": "INDIANOLA",
            "state": "IA",
            "postal_code": "501252892",
            "telephone_number": "712-370-3910",
            "fax_number": "888-573-6009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-02",
        "last_updated": "2026-08-22",
        "certification_date": "2026-08-22",
        "status": "A",
        "authorized_official_last_name": "RINES",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER/NP",
        "authorized_official_telephone_number": "712-370-3910",
        "authorized_official_credential": "ARNP, MSN, RN"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Indianola, IA
• Providers in Indianola, IA by specialty
• Primary Care Clinic/Center in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.