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

Name	Role	Since
Douglas a Wells Individual	Corporate Director	May 1, 2013
Whitey Stange Individual	Corporate Director	May 1, 2017
Dwight Travis Tomes Individual	Corporate Director	May 1, 2013
James P Obradovich Individual	Corporate Director	May 1, 2013
Nancy S Boyd Individual	Corporate Director	May 1, 2013
James Hoffman Individual	Corporate Director	May 1, 2017
Jamey Cox Individual	Corporate OfficerCfo	Jan 14, 2008
Jamey Cox Individual	W-2 Managing EmployeeCfo	Oct 8, 2013
Candy Morgan Individual	Corporate Director	May 1, 2017
Mike R Hamilton Individual	Corporate Director	May 1, 2013
Mark Teigland Individual	Corporate OfficerCeo	Jul 1, 2013
Mark Teigland Individual	W-2 Managing EmployeeCeo	Oct 6, 2009
Jamey K Smith Individual	Corporate Director	May 1, 2013
Robyn Mills Individual	Corporate Director	May 1, 2017

Medicare enrollment records 1

Medicare enrollment files

Enrollment ID	State	Provider type	PAC ID	Details
O20021203000013	IA	Part a Provider - Skilled Nursing Facility	9133037385	Practice locations: Des Moines, IA

National Provider Directory

Locations

4210 Hickman Rd
Des Moines, IA 50310
Phone (515) 277-6141

Specialties & licenses 1

NPPES NPI Registry

Specialty (taxonomy)	Code	License	State	Primary
Skilled Nursing Facility	314000000X	770368	IA	Primary

Addresses

NPPES NPI Registry

Primary practice location

4210 Hickman Rd
Des Moines, IA 50310-3333

Mailing address

4210 Hickman Rd
Des Moines, IA 50310-3333
Phone (515) 277-6141

Other identifiers 2

NPPES NPI Registry

Identifier	Type	State	Issuer
4821930001	Other		MEDICARE DMERCS
0800417	Medicaid	IA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 27, 2013.

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385510400000",
    "number": "1447248372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4210 HICKMAN RD",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503103333",
            "telephone_number": "515-277-6141",
            "fax_number": "515-271-0933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4210 HICKMAN RD",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503103333",
            "telephone_number": "515-277-6141",
            "fax_number": "515-271-0933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALVIN COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-13",
        "last_updated": "2013-11-27",
        "status": "A",
        "authorized_official_last_name": "TEIGLAND",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "515-277-6141",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IA",
            "license": "770368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DMERCS",
            "identifier": "4821930001",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0800417",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.