NPIMap

Organization Active NPI

Unitypoint Health - Marshalltown

Doing business as Unitypoint Health - Marshalltown - Family Medicine Clinic

  • Rural Health Clinic/Center
  • Marshalltown, IA
National Provider Identifier
1396279907
Registry record updated Apr 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
UNITYPOINT HEALTH - MARSHALLTOWN
Doing business as
Unitypoint Health - Marshalltown - Family Medicine Clinic
Practice address
303 Nicholas Dr Ste 100
Marshalltown, IA 50158-4443
Phone
(641) 753-2752
NPI assigned
Apr 20, 2017
Last updated
Apr 27, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
UNITYPOINT HEALTH - MARSHALLTOWNAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 27, 2022

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

Authorized official

Name
Pamela K. Delagardelle
Title
Ceo
Phone
(319) 235-3606

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Certified Registered Nurse Anesthetist 367500000X NU
Pain Medicine (Anesthesiology) Physician 207LP2900X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU
Orthopaedic Surgery Physician 207X00000X NU
Surgery Physician 208600000X NU
Podiatrist 213E00000X NU

Addresses

Primary practice location

303 Nicholas Dr Ste 100
Marshalltown, IA 50158-4443

Mailing address

55 Unitypoint Way
Marshalltown, IA 50158-4749
Phone (641) 754-5145

Other practice location 1

405 E Main St Fl 1
Marshalltown, IA 50158-1928
Phone (641) 754-5151

Other names 1

  • UNITYPOINT HEALTH - MARSHALLTOWN - FAMILY MEDICINE CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170511000530 IA Part A Provider - Rural Health Clinic 0941587307 Practice locations: Marshalltown, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396279907. Details of each certification follow.

Rural health clinic certification: CCN 168578

Legal name
UNITYPOINT HEALTH - MARSHALLTOWN
Doing business as
UNITYPOINT HEALTH - MARSHALLTOWN - FAMILY MEDICINE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 28, 2016
Last certification
Jan 12, 2023
Ownership / control type
2B
Most recent change of ownership
May 1, 2017 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Dec 12, 2016 in IA
Enrollment address
303 Nicholas Dr
Ste 100
Marshalltown, IA 50158-4443
Related CCNs
160001

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

Other NPIs with the same Medicare PAC ID 9

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

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
16D1060874Unitypoint Health Marshalltown303 Nicholas Drive, Suite 100, Marshalltown, IA 50158Certificate of waiverNov 2, 2026

National Provider Directory

National Provider Directory
Tax ID family
Unitypoint Marshalltown10 organizations share this tax ID, including this one
Part of
Unitypoint Marshalltown

Other organizations with this tax ID 9

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

Locations

405 E Main St
Fl 1
Marshalltown, IA 50158
Phone (641) 754-5151

1307 S Broadway St
Uppr
Toledo, IA 52342
Phone (641) 484-5445

Ownership & related parties

All disclosed owners & managing parties 23

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

NameRoleSinceShare
Kalyana Sundaram Individual Corporate Director Jan 1, 2020
Lance Horbach Individual Corporate Officer Jan 1, 2020
Corporate Director May 1, 2017
Joan I Headington Individual Corporate Director Jan 1, 2020
Henry Bevel Individual Corporate Director Jan 1, 2020
Clay Holderman Individual Other Feb 8, 2021
Michael Byl Individual Corporate Officer Jan 1, 2022
Corporate Director Jan 1, 2020
Pradeep M Ramesh Individual Corporate Director Jan 1, 2022
Joseph Tripp-Rieks Individual Corporate Director Jan 1, 2020
Shellayne Boldt Individual Contracted Managing EmployeeReg Dir of Primary Care Services Aug 5, 2018
Operational/Managerial ControlReg Dir of Primary Care Services Aug 5, 2018
Robert Buckley Individual Corporate Director May 1, 2017
Sharon K King Individual W-2 Managing EmployeeHospital Administrator Jun 7, 2020
Operational/Managerial ControlHospital Administrator Jun 7, 2020
Steven T Scurr Individual Contracted Managing EmployeeMedical Director May 1, 2017
Operational/Managerial ControlMedical Director May 1, 2017
Iowa Health System Organization, West Des Moines, IA Corporation, Non-profit Operational/Managerial Control Dec 12, 2016
Mary Wertzberger Individual Corporate Director May 1, 2017
Stacey Bentley Individual Corporate Officer Jan 1, 2020
Corporate Director Jan 1, 2020
Allen Health Systems Inc Organization, Waterloo, IA Corporation, Non-profit Operational/Managerial Control Dec 12, 2016
Michelle Peterson Individual W-2 Managing EmployeeWorking Supervisor Jun 20, 2021
Operational/Managerial ControlWorking Supervisor Jun 20, 2021
Shannon M Roder Individual W-2 Managing EmployeeClinic Administrator Jun 20, 2021
Operational/Managerial ControlClinic Administrator Jun 20, 2021
Carolyn Barko Individual Contracted Managing EmployeeRegional Ambulatory Vice President Jan 18, 2022
Operational/Managerial ControlRegional Ambulatory Vice President Jan 18, 2022
Sherry Khurana Individual Contracted Managing EmployeeAssoc Med Dir, Primary Care Service Apr 13, 2017
Operational/Managerial ControlAssoc Med Dir, Primary Care Service Apr 13, 2017
Kyle P Christiason Individual Corporate Officer Jan 1, 2022
Corporate Director Jan 1, 2020
Daniel G Glascock Individual Contracted Managing EmployeeVice President/Medical Director Aug 12, 2015
Operational/Managerial ControlVice President/Medical Director Aug 12, 2015
Jennifer a Friedly Individual Contracted Managing EmployeeMarket President Jun 12, 2018
Corporate OfficerMarket President Jun 12, 2018
Operational/Managerial ControlMarket President Jun 12, 2018

Owners & managing parties with NPI records 5

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

Facilities with the same owner 69

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

View all 69

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1492646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651017600000",
    "number": "1396279907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 UNITYPOINT WAY",
            "city": "MARSHALLTOWN",
            "state": "IA",
            "postal_code": "501584749",
            "telephone_number": "641-754-5145",
            "fax_number": "641-844-6208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 NICHOLAS DR STE 100",
            "city": "MARSHALLTOWN",
            "state": "IA",
            "postal_code": "501584443",
            "telephone_number": "641-753-2752"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "405 E Main St Fl 1",
            "address_purpose": "LOCATION",
            "city": "Marshalltown",
            "state": "IA",
            "postal_code": "501581928",
            "country_code": "US",
            "telephone_number": "641-754-5151",
            "fax_number": "641-844-6208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "UNITYPOINT HEALTH - MARSHALLTOWN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNITYPOINT HEALTH - MARSHALLTOWN",
        "enumeration_date": "2017-04-20",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A",
        "authorized_official_last_name": "DELAGARDELLE",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "319-235-3606"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UNITYPOINT HEALTH - MARSHALLTOWN - FAMILY MEDICINE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marshalltown, IA

Sources for this page

Verify at the official NPI Registry.