NPIMap

Organization Active NPI

Mitchell County Memorial Hospital

  • Certified Registered Nurse Anesthetist
  • Osage, IA
National Provider Identifier
1407925522
Registry record updated Dec 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
MITCHELL COUNTY MEMORIAL HOSPITAL
Practice address
616 N 8TH St
Osage, IA 50461-1456
Phone
(641) 732-6000
Fax
(641) 732-6025
NPI assigned
Nov 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2020

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

Authorized official

Name
Michele Marie Russell
Title
Ceo
Phone
(641) 732-6003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

616 N 8TH St
Osage, IA 50461-1456

Mailing address

616 N 8TH St
Osage, IA 50461-1456
Phone (641) 732-6000

Other identifiers 3

IdentifierTypeStateIssuer
0133702MedicaidIA
IA0100OtherIACRNA JOHN DEERE
42382OtherIACRNA BCBS

Other names 1

  • Mitchell County Regional Health Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address MI.MHN.HIM@direct.2.mycarefile.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040127000973 IA Part B Supplier - Clinic/Group Practice 5890603070 Receives reassigned benefits from 22 practitioners
4 other NPIs on this enrollment
Practice locations: Saint Ansgar, IA; Riceville, IA; Osage, IA

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Mitchell Co Reg HLTH5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

411 S Broad St
#145
Stacyville, IA 50476
Phone (641) 737-2406

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Riceville ClinicRiceville, IA, CCN 163497 Rural health clinic Operational/Managerial Control Sep 1, 1994
Mitchell County Regional Health Center-Osage ClinicOsage, IA, CCN 163454 Rural health clinic Operational/Managerial Control Sep 1, 1994
St Ansgar ClinicSaint Ansgar, IA, CCN 163445 Rural health clinic Operational/Managerial Control Sep 1, 1994

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607299200000",
    "number": "1407925522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 N 8TH ST",
            "city": "OSAGE",
            "state": "IA",
            "postal_code": "504611456",
            "telephone_number": "641-732-6000",
            "fax_number": "641-732-6025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 N 8TH ST",
            "city": "OSAGE",
            "state": "IA",
            "postal_code": "504611456",
            "telephone_number": "641-732-6000",
            "fax_number": "641-732-6025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITCHELL COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "641-732-6003"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0133702",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRNA JOHN DEERE",
            "identifier": "IA0100",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRNA BCBS",
            "identifier": "42382",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MI.MHN.HIM@direct.2.mycarefile.org",
            "affiliation": "N",
            "endpointDescription": "Mitchell County Regional Health Center",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "616 N 8th St",
            "city": "Osage",
            "state": "IA",
            "country_code": "US",
            "postal_code": "504611456",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mitchell County Regional Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Osage, IA

Sources for this page

Verify at the official NPI Registry.