Infinity Health
Organization Active NPI Federally Qualified Health Center (FQHC) · Mount Ayr, IA
NPI 1396384657 · NPPES record last updated May 18, 2023
Key facts
- NPI
- 1396384657
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 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
- Organization subpart
- No
Authorized official
- Name
- Samantha Cannon
- Title
- Ceo
- Phone
- (641) 446-2383
Other NPIs on the same Medicare enrollment 9
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 12
Practitioners 19
-
Sandy Marcus, PMHNP-BC
-
Nathan B. Allen, D.O.
-
Elizabeth Marie Brant, ARNP, FNP-C
-
Evelyn Lee Conrad, LMSW
-
Jena Rae Ellerhoff, DNP, ARNP, PMHNP-BC
-
Melissa Groh, LMSW
-
Kylie Kent, LMSW
-
Mackenzie Kirk, PMHNP-BC
-
Regina M Lassabe, LPC, LMHC
-
Jordan Marie McCloney, NP-C
-
Danielle Lea O'Brien, M.S., C.R.C.
-
Jennifer Spoerl, ARNP
-
Andrew Sullivan, PA-C
-
Stacy Lynn Tallman, LMSW
-
John Young, LMHC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA
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
- Corporation · Non-profit
- Enrollment address
- 1201 E South St
Mount Ayr, IA 50854-2177
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Shirley Kessel |
Corporate Director |
Jan 1, 2005 | |
| Pamela Burlin |
Corporate Director |
Nov 30, 2021 | 11.1% |
| Alan Wilson |
Corporate Director |
Mar 23, 2010 | 11.1% |
| William Morain |
Corporate Director |
Jan 1, 2005 | 11.1% |
| Dien Judge |
Corporate Director |
Jan 24, 2017 | |
| Kyle E Ahlenstorf |
Corporate Officer | Dec 27, 2023 | |
| Corporate Director |
Dec 27, 2023 | ||
| W-2 Managing Employee |
Dec 27, 2023 | ||
| Marvin McCann |
Corporate Director |
Apr 27, 2021 | 11.1% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Infinity Health
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 507202208 | Medicaid | MO | |
| 0462887 | Medicaid | IA |
Other providers in Mount Ayr, IA
- Courtney Kaye Halls
- Christina Noelle Hanson
- Dennis Stanley Hemann
- Kasandra Jane Higdon
- Hy-Vee Inc
- Anna M Johnson
- Dana Knight Johnson
- Virginia Larsen
- Erin Rachel Leonard
- Mount Ayr CSD
All providers in Mount Ayr, IA · Federally Qualified Health Center (FQHC) in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.