NPIMap

Organization Active NPI

Infinity Health

  • Federally Qualified Health Center (FQHC)
  • Mount Ayr, IA
National Provider Identifier
1396384657
Registry record updated May 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
INFINITY HEALTH
Practice address
1201 E South St
Mount Ayr, IA 50854-2177
Phone
(641) 321-3020
Fax
(515) 864-0336
NPI assigned
Jan 3, 2020
Last updated
May 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2023

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

Authorized official

Name
Samantha Cannon
Title
Ceo
Phone
(641) 446-2383

Specialties & licenses 1

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

Addresses

Primary practice location

1201 E South St
Mount Ayr, IA 50854-2177

Mailing address

302 NE 14TH St
Leon, IA 50144-1206
Phone (641) 446-2383

Other identifiers 2

IdentifierTypeStateIssuer
0462887MedicaidIA
507202208MedicaidMO

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051024000374 IA Part B Supplier - Clinic/Group Practice 5597717496 Receives reassigned benefits from 27 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Albia, IA; Centerville, IA; Chariton, IA; Corydon, IA; Knoxville, IA; Lamoni, IA; Leon, IA; Mount Ayr, IA…
O20200211001398 IA Part A Provider - Federally Qualified Health Center (FQHC) 5597717496 Practice locations: Mount Ayr, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396384657. Details of each certification follow.

Federally qualified health center certification: CCN 161891

Legal name
INFINITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 4, 2020
Last certification
Feb 4, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1201 E South St
Mount Ayr, IA 50854-2177

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Infinity Health - Archived13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Shirley Kessel Individual Corporate DirectorBoard Chair Jan 1, 2005
Pamela Burlin Individual Corporate DirectorBoard Member Nov 30, 2021 11.1%
Alan Wilson Individual Corporate DirectorBoard Member Mar 23, 2010 11.1%
William Morain Individual Corporate DirectorBoard Secretary Jan 1, 2005 11.1%
Dien Judge Individual Corporate DirectorVice Chair Jan 24, 2017
Kyle E Ahlenstorf Individual Corporate Officer Dec 27, 2023
Corporate DirectorCeo Dec 27, 2023
W-2 Managing EmployeeCeo Dec 27, 2023
Marvin McCann Individual Corporate DirectorBoard Member Apr 27, 2021 11.1%

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": "1578009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684368000000",
    "number": "1396384657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 NE 14TH ST",
            "city": "LEON",
            "state": "IA",
            "postal_code": "501441206",
            "telephone_number": "641-446-2383",
            "fax_number": "641-446-2382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 E SOUTH ST",
            "city": "MOUNT AYR",
            "state": "IA",
            "postal_code": "508542177",
            "telephone_number": "641-321-3020",
            "fax_number": "515-864-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFINITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-03",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A",
        "authorized_official_last_name": "CANNON",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "641-446-2383"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0462887",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507202208",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Ayr, IA

Sources for this page

Verify at the official NPI Registry.