NPIMap

Organization Active NPI

Trinity Regional Medical Center

Doing business as Unitypoint Clinic Pediatrics Fort Dodge

  • Rural Health Clinic/Center
  • Fort Dodge, IA
National Provider Identifier
1447778170
Registry record updated Nov 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TRINITY REGIONAL MEDICAL CENTER
Doing business as
Unitypoint Clinic Pediatrics Fort Dodge
Practice address
804 Kenyon Rd Ste D
Fort Dodge, IA 50501-5744
Phone
(515) 574-6855
Fax
(515) 573-7274
NPI assigned
Sep 1, 2017
Last updated
Nov 19, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
TRINITY REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 19, 2024

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

Authorized official

Name
Leah M Glasgo
Title
Market President
Phone
(515) 573-3101

Specialties & licenses 1

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

Addresses

Primary practice location

804 Kenyon Rd Ste D
Fort Dodge, IA 50501-5744

Mailing address

802 Kenyon Rd
Fort Dodge, IA 50501-5740
Phone (515) 574-6565

Other names 1

  • UNITYPOINT CLINIC PEDIATRICS FORT DODGE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171206000028 IA Part A Provider - Rural Health Clinic 7315858529 Practice locations: Fort Dodge, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447778170. Details of each certification follow.

Rural health clinic certification: CCN 168603

Legal name
TRINITY REGIONAL MEDICAL CENTER
Doing business as
UNITYPOINT CLINIC PEDIATRICS FORT DODGE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 14, 2015
Last certification
Mar 24, 2021
Ownership / control type
2B
Most recent change of ownership
Dec 24, 2017 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Jun 8, 1973 in IA
Enrollment address
804 Kenyon Rd
Ste D
Fort Dodge, IA 50501-5744
Related CCNs
160016

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

Other NPIs with the same Medicare PAC ID 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Unitypoint Health21 organizations share this tax ID, including this one
Part of
Unitypoint Health

Other organizations with this tax ID 20

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

View all 20

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Lincoln R Wallace Individual Corporate Officer Jan 1, 2018
Corporate Director Jan 1, 2015
Charles Clayton Individual Corporate Director Jan 1, 2022
Trinity Health Systems, Inc Organization, Fort Dodge, IA Corporation, Non-profit Operational/Managerial Control Nov 4, 1983
Clay Holderman Individual OtherChain Home Office Administrator Feb 8, 2021
Amanda M Lyon Individual Contracted Managing EmployeeDirector of Clinic Operations Aug 29, 2021
Operational/Managerial ControlDirector of Clinic Operations Aug 29, 2021
Neven Conrad Individual Corporate Officer Jan 1, 2020
Corporate Director Jan 1, 2017
Sarah Marsh Individual Contracted Managing EmployeeVice President- Finance Dec 9, 2019
Corporate OfficerVice President- Finance Dec 9, 2019
Operational/Managerial ControlVice President- Finance Dec 9, 2019
Christine R Frideres Individual Corporate Officer Jan 1, 2023
Corporate Director Jan 1, 2016
Debra D Johnson Individual Corporate Director Jan 1, 2013
Michael J Frischmeyer Individual Corporate Director Jan 1, 2014
Leah M Glasgo Individual Contracted Managing EmployeePresident & Ceo Jan 28, 2019
Corporate OfficerPresident & Ceo Jan 28, 2019
Corporate DirectorPresident & Ceo Jan 28, 2019
Operational/Managerial ControlPresident & Ceo Jan 28, 2019
Iowa Health System Organization, West Des Moines, IA Corporation, Non-profit Operational/Managerial Control Dec 31, 1998
Michael J Willerth Individual Corporate Director Jan 1, 2013
Michael Lee Individual Contracted Managing EmployeeRegional VP/Medical Director Jan 1, 2022
Corporate Director Oct 28, 2021
Operational/Managerial ControlRegional VP/Medical Director Jan 1, 2022
Jennifer Crimmins Individual Contracted Managing EmployeeRegional VP/Clinic Operations Feb 1, 2019
Operational/Managerial ControlRegional VP/Clinic Operations Feb 1, 2019
Jill Nelson Individual Corporate Director Jan 1, 2022
Eric D Haugen Individual Contracted Managing EmployeeMedical Director May 1, 2022
Operational/Managerial ControlMedical Director May 1, 2022
Sarah N Jones Individual W-2 Managing EmployeeClinic Administrator Nov 23, 2020
Operational/Managerial ControlClinic Administrator Nov 23, 2020
Keith Kolacia Individual Corporate Director Jan 1, 2022
Kari L Jones Individual W-2 Managing EmployeeCne Jul 6, 2020
Operational/Managerial ControlCne Jul 6, 2020

Owners & managing parties with NPI records 4

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

Facilities with the same owner 79

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

View all 79

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1504224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731974400000",
    "number": "1447778170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 KENYON RD",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505015740",
            "telephone_number": "515-574-6565",
            "fax_number": "515-574-6504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 KENYON RD STE D",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505015744",
            "telephone_number": "515-574-6855",
            "fax_number": "515-573-7274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRINITY REGIONAL MEDICAL CENTER",
        "enumeration_date": "2017-09-01",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A",
        "authorized_official_last_name": "GLASGO",
        "authorized_official_first_name": "LEAH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MARKET PRESIDENT",
        "authorized_official_telephone_number": "515-573-3101"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UNITYPOINT CLINIC PEDIATRICS FORT DODGE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UNITYPOINT CLINIC PEDIATRICS FORT DODGE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Dodge, IA

Sources for this page

Verify at the official NPI Registry.