NPIMap

Organization Active NPI

Shenandoah Medical Center

Doing business as Shenandoah Physicians Clinic

  • Rural Health Clinic/Center
  • Shenandoah, IA
National Provider Identifier
1427300201
Registry record updated Jul 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
730065H Issued in IA
Legal business name
SHENANDOAH MEDICAL CENTER
Doing business as
Shenandoah Physicians Clinic
Practice address
1 Jack Foster Dr
Shenandoah, IA 51601-4586
Phone
(712) 246-7240
Fax
(712) 246-7357
NPI assigned
Oct 4, 2012
Last updated
Jul 28, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2026

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

Authorized official

Name
Matthew Sells
Title
Ceo
Phone
(712) 246-7160

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 730065H IA Primary
Family Medicine Physician 207Q00000X 730065H IA
Internal Medicine Physician 207R00000X 730065H IA

Addresses

Primary practice location

1 Jack Foster Dr
Shenandoah, IA 51601-4586

Mailing address

300 Pershing Ave
PO Box 380
Shenandoah, IA 51601-2355
Phone (712) 246-7240

Other names 1

  • Shenandoah Physicians Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040209000347 IA Part B Supplier - Clinic/Group Practice 9436063237 Receives reassigned benefits from 90 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Essex, IA; Hamburg, IA; Red Oak, IA; Shenandoah, IA; Sidney, IA; Tabor, IA
O20101018000540 IA Part A Provider - Rural Health Clinic 9436063237 1 other NPI on this enrollment
Practice locations: Shenandoah, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427300201. Details of each certification follow.

Rural health clinic certification: CCN 168549

Legal name
SHENANDOAH MEDICAL CENTER
Doing business as
SHENANDOAH PHYSICIANS CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 19, 2012
Last certification
Nov 8, 2018
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Mar 30, 1978 in IA
Enrollment address
1 Jack Foster Dr
Shenandoah, IA 51601-4586
Related CCNs
161366

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 7

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

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
16D2090992Shenandoah Physicians Clinic1 Jack Foster Drive, Shenandoah, IA 51601Provider-performed microscopyFeb 2, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Matthew R Sells Individual Corporate OfficerCeo May 1, 2017 100%
W-2 Managing EmployeeCeo Jul 28, 2014 100%
Alissa McGinnis Individual Corporate DirectorBoard Member Jul 1, 2012 100%
Edward J Kloberdanz Individual Corporate DirectorBoard Member Jul 1, 2012 100%
Shenandoah Medical Center Organization, Shenandoah, IA Corporation 5% Or Greater Direct Ownership Interest Aug 31, 2010
Operational/Managerial Control Aug 31, 2010

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Shenandoah Memorial HospitalShenandoah, IA, CCN 161366 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 1, 1985
Oct 19, 2007
Shenandoah Memorial HospitalShenandoah, IA, CCN 16Z366 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1979
Shenandoah Physicians Clinic-SidneySidney, IA, CCN 168569 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2014
Shenandoah Physcians Clinic-TaborTabor, IA, CCN 168645 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 45

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.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1349308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785196800000",
    "number": "1427300201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PERSHING AVE",
            "address_2": "PO BOX 380",
            "city": "SHENANDOAH",
            "state": "IA",
            "postal_code": "516012355",
            "telephone_number": "712-246-7240",
            "fax_number": "712-246-7357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 JACK FOSTER DR",
            "city": "SHENANDOAH",
            "state": "IA",
            "postal_code": "516014586",
            "telephone_number": "712-246-7240",
            "fax_number": "712-246-7357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHENANDOAH MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-04",
        "last_updated": "2026-07-28",
        "certification_date": "2026-07-28",
        "status": "A",
        "authorized_official_last_name": "SELLS",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-246-7160"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IA",
            "license": "730065H",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "730065H",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "730065H",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shenandoah Physicians Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shenandoah, IA

Sources for this page

Verify at the official NPI Registry.