NPIMap

Organization Active NPI

Sioux Center Health

Doing business as Sioux Center Medical Clinic General Surgery

  • Surgery Physician
  • Sioux Center, IA
National Provider Identifier
1407107923
Registry record updated Apr 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SIOUX CENTER HEALTH
Doing business as
Sioux Center Medical Clinic General Surgery
Practice address
1101 9 St SE
Sioux Center, IA 51250-2501
Phone
(712) 722-2609
Fax
(712) 722-8426
NPI assigned
Sep 24, 2012
Last updated
Apr 20, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SIOUX CENTER HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2023

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

Authorized official

Name
Crystal Richter
Title
Cfo
Phone
(712) 722-8153

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

1101 9 St SE
Sioux Center, IA 51250-2501

Mailing address

1101 9 St SE
Sioux Center, IA 51250-2501
Phone (712) 722-2609

Other names 1

  • Sioux Center Medical Clinic General Surgery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040224001315 IA Part B Supplier - Clinic/Group Practice 9032027495 Receives reassigned benefits from 55 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hull, IA; Sioux Center, IA; Lemars, IA; Hawarden, IA

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Sioux Center Comm HSP H11 organizations share this tax ID, including this one
Part of
Sioux Center Comm HSP H

Other organizations with this tax ID 10

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

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": "1348444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681948800000",
    "number": "1407107923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 9 ST SE",
            "city": "SIOUX CENTER",
            "state": "IA",
            "postal_code": "512502501",
            "telephone_number": "712-722-2609",
            "fax_number": "712-722-8426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 9 ST SE",
            "city": "SIOUX CENTER",
            "state": "IA",
            "postal_code": "512502501",
            "telephone_number": "712-722-2609",
            "fax_number": "712-722-8426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIOUX CENTER HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SIOUX CENTER HEALTH",
        "enumeration_date": "2012-09-24",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A",
        "authorized_official_last_name": "RICHTER",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "712-722-8153"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sioux Center Medical Clinic General Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sioux Center Medical Clinic General Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux Center, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; 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.