NPIMap

Organization Active NPI

Burgess Health Center

  • Rural Health Clinic/Center
  • Whiting, IA
National Provider Identifier
1487022216
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BURGESS HEALTH CENTER
Practice address
153 Blair St
Whiting, IA 51063-1007
Phone
(712) 455-2431
Fax
(712) 455-2698
NPI assigned
Sep 10, 2015
Organization subpart
Yes
Parent organization
BURGESS HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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

Authorized official

Name
Lynn R Wold
Title
Ceo
Phone
(712) 423-2311

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Rural Health Clinic/Center 261QR1300X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

153 Blair St
Whiting, IA 51063-1007

Mailing address

1600 Diamond St
Onawa, IA 51040-1548
Phone (712) 423-2311

Other names 1

  • BURGESS CLINIC - WHITING Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031219000549 IA Part B Supplier - Clinic/Group Practice 0143131516 Receives reassigned benefits from 27 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Onawa, IA

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Part of
Burgess Health Center

Locations

612 Iowa Ave
Ste A
Dunlap, IA 51529
Phone (712) 643-5162

612 Iowa Ave
Rm 78
Dunlap, IA 51529
Phone (712) 643-5884

1112 17th St
Onawa, IA 51040
Phone (712) 423-9160

Practitioners & affiliated clinicians

Practitioners 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1441843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1487022216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 DIAMOND ST",
            "city": "ONAWA",
            "state": "IA",
            "postal_code": "510401548",
            "telephone_number": "712-423-2311",
            "fax_number": "712-423-9199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 BLAIR ST",
            "city": "WHITING",
            "state": "IA",
            "postal_code": "510631007",
            "telephone_number": "712-455-2431",
            "fax_number": "712-455-2698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURGESS HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BURGESS HEALTH CENTER",
        "enumeration_date": "2015-09-10",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "WOLD",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-423-2311"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BURGESS CLINIC - WHITING",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BURGESS CLINIC - WHITING",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Whiting, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.