NPIMap

Waverly Health Center

Organization Active NPI Rural Health Clinic/Center · Nashua, IA

NPI 1447432174 · NPPES record last updated Jun 5, 2024

Key facts

NPI
1447432174
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
WAVERLY HEALTH CENTER
Practice address
80 Amhearst Boulevard
Suite 400
Nashua, IA 50658-9712
Phone
(641) 435-4133
NPI assigned
Dec 5, 2007
Organization subpart
Yes
Parent organization (as reported)
WAVERLY HEALTH CENTER

Authorized official

Name
Ms. Jodi M Geerts
Title
Ceo
Phone
(319) 352-4120

Owners & managing parties with NPI records 2

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

Other NPIs with the same Medicare PAC ID 9

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

Corporate family (same tax ID) 11

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

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

Practitioners 44

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

View all 44

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D1076320Waverly Health Center
80 Amhearst Boulevard, Suite 400, Nashua, IA 50658		Certificate of waiverJun 29, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IA

Rural health clinic certification: CCN 168527

Legal name
WAVERLY HEALTH CENTER
Doing business as
NASHUA CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 1, 2008
Last certification
Jan 19, 2023
Ownership / control type
2B
Organization structure
Other · Non-profit
Enrollment address
80 Amhearst Blvd
Ste 400
Nashua, IA 50658-9712
Related CCNs
161339

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Ann Henninger Trax
Individual 		Corporate Officer Jan 7, 2022
Corporate Director Jan 1, 2020
Courtney C Bochmann
Individual 		W-2 Managing Employee
Medical Director		 Jul 1, 2022
Operational/Managerial Control
Medical Director		 Jul 1, 2022
Jodi M Geerts
Individual 		Corporate Officer
Ceo		 Jan 18, 2023
W-2 Managing Employee
Ceo		 Jan 18, 2023
Operational/Managerial Control
Ceo		 Jan 18, 2023
Philip S Jones
Individual 		Corporate Officer Jan 7, 2022
Corporate Director Aug 31, 2021
David J Rathe
Individual 		Corporate Director Jan 1, 2024
Laurie Everhardt
Individual 		Corporate Director Jan 1, 2022
Nicole C Myers
Individual 		W-2 Managing Employee
Ad;Chief Clinic Officer		 May 16, 2023
Operational/Managerial Control
Chief Clinic Officer		 May 16, 2023

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20071221000461 IA Part a Provider - Rural Health Clinic 8820996762 Practice locations: Nashua, IA

National Provider Directory

Tax ID family
Waverly Municipal Hospital (12 organizations share this tax ID)
Part of
Waverly Municipal Hospital

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

80 Amhearst Boulevard
Suite 400
Nashua, IA 50658-9712

Mailing address

312 9TH St SW
Waverly, IA 50677-2929
Phone (319) 352-4120

Other names

  • Nashua Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 5, 2024.

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1447432174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 9TH ST SW",
            "city": "WAVERLY",
            "state": "IA",
            "postal_code": "506772929",
            "telephone_number": "319-352-4120",
            "fax_number": "319-352-3992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 AMHEARST BOULEVARD",
            "address_2": "SUITE 400",
            "city": "NASHUA",
            "state": "IA",
            "postal_code": "506589712",
            "telephone_number": "641-435-4133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAVERLY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAVERLY HEALTH CENTER",
        "enumeration_date": "2007-12-05",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "GEERTS",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "319-352-4120",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nashua Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nashua, IA

All providers in Nashua, IA · Rural Health Clinic/Center in Iowa

Sources for this page

Verify at the official NPI Registry.