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Organization Active NPI

Clarinda Regional Health Center

  • Rural Health Clinic/Center
  • Villisca, IA
National Provider Identifier
1477592343
Registry record updated May 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CLARINDA REGIONAL HEALTH CENTER
Practice address
309 S 5TH Ave
Villisca, IA 50864-1160
Phone
(712) 826-3003
NPI assigned
Jun 6, 2006
Organization subpart
Yes
Parent organization
CLARINDA REGIONAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 21, 2014

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

Authorized official

Name
Elaine Otte
Title
Coo
Phone
(712) 542-2176

Specialties & licenses 1

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

Addresses

Primary practice location

309 S 5TH Ave
Villisca, IA 50864-1160

Mailing address

P O Box 217
Clarinda, IA 51632-2625

Other names 1

  • Villisca Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100112000568 IA Part A Provider - Rural Health Clinic 4587573993 Practice locations: Villisca, IA

Rural health clinic certification: CCN 163464

Legal name
CLARINDA REGIONAL HEALTH CENTER
Doing business as
VILLISCA FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 5, 1997
Last certification
Jul 26, 2021
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
in IA
Enrollment address
309 S 5TH Ave
Villisca, IA 50864-1160
Related CCNs
161352

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Clarinda Regional Center11 organizations share this tax ID, including this one
Part of
Clarinda Regional Center

Other organizations with this tax ID 10

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
City of Clarinda Organization, Clarinda, IA 5% Or Greater Direct Ownership Interest Nov 14, 2007 100%
Tyler Hill Individual Corporate OfficerCno Dec 5, 2018 100%
W-2 Managing EmployeeCno Dec 5, 2018 100%
Charles W. Nordyke Individual Corporate OfficerCeo/Administrator Jun 29, 2018 100%
W-2 Managing EmployeeCeo/Administrato Feb 1, 2021 100%

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 46

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

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400630400000",
    "number": "1477592343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 217",
            "city": "CLARINDA",
            "state": "IA",
            "postal_code": "516322625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 S 5TH AVE",
            "city": "VILLISCA",
            "state": "IA",
            "postal_code": "508641160",
            "telephone_number": "712-826-3003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARINDA REGIONAL HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLARINDA REGIONAL HEALTH CENTER",
        "enumeration_date": "2006-06-06",
        "last_updated": "2014-05-21",
        "status": "A",
        "authorized_official_last_name": "OTTE",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "712-542-2176"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Villisca Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Villisca, IA

Sources for this page

Verify at the official NPI Registry.