NPIMap

Organization Active NPI

Shenandoah Medical Center

Doing business as Shenandoah Physicians Clinic-Sidney

  • Rural Health Clinic/Center
  • Sidney, IA
National Provider Identifier
1497150825
Registry record updated Jul 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
730065H Issued in IA
Legal business name
SHENANDOAH MEDICAL CENTER
Doing business as
Shenandoah Physicians Clinic-Sidney
Practice address
802 Illinois St
Sidney, IA 51652-8028
Phone
(712) 374-6005
Fax
(712) 374-3100
NPI assigned
Oct 28, 2014
Last updated
Jul 28, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2026

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

Authorized official

Name
Matthew Sells
Title
Ceo
Phone
(712) 246-7160

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 730065H IA Primary

Addresses

Primary practice location

802 Illinois St
Sidney, IA 51652-8028

Mailing address

300 Pershing Ave
Shenandoah, IA 51601-2355
Phone (712) 246-1230

Other names 1

  • Shenandoah Physicians Clinic-Sidney Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141205001157 IA Part A Provider - Rural Health Clinic 9436063237 Practice locations: Sidney, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497150825. Details of each certification follow.

Rural health clinic certification: CCN 168569

Legal name
SHENANDOAH MEDICAL CENTER
Doing business as
SHENANDOAH PHYSICIANS CLINIC-SIDNEY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 17, 2015
Last certification
Jun 21, 2018
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 30, 1978 in IA
Enrollment address
802 Illinois St
Sidney, IA 51652-8028
Related CCNs
161366

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

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Shenandoah Outpatient C15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Roger D Jones Individual Corporate DirectorBoaed Member Aug 1, 2012 100%
Matthew R Sells Individual Corporate OfficerCfo Apr 10, 2017 100%
W-2 Managing EmployeeCfo Jul 28, 2014 100%
Alissa McGinnis Individual Corporate DirectorBoard Member Jul 1, 2012 100%
Edward J Kloberdanz Individual Corporate DirectorBoard Member Jul 1, 2012 100%
Shenandoah Medical Center Organization, Shenandoah, IA Non-profit 5% Or Greater Direct Ownership Interest Dec 1, 2014 100%

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Shenandoah Memorial HospitalShenandoah, IA, CCN 161366 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 1, 1985
Oct 19, 2007
Shenandoah Memorial HospitalShenandoah, IA, CCN 16Z366 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1979
Shenandoah Physicians ClinicShenandoah, IA, CCN 168549 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Aug 31, 2010
Aug 31, 2010
Shenandoah Physcians Clinic-TaborTabor, IA, CCN 168645 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

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

NPI Registry JSON

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

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785196800000",
    "number": "1497150825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PERSHING AVE",
            "city": "SHENANDOAH",
            "state": "IA",
            "postal_code": "516012355",
            "telephone_number": "712-246-1230",
            "fax_number": "712-246-7357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 ILLINOIS ST",
            "city": "SIDNEY",
            "state": "IA",
            "postal_code": "516528028",
            "telephone_number": "712-374-6005",
            "fax_number": "712-374-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHENANDOAH MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-28",
        "last_updated": "2026-07-28",
        "certification_date": "2026-07-28",
        "status": "A",
        "authorized_official_last_name": "SELLS",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-246-7160"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IA",
            "license": "730065H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shenandoah Physicians Clinic-Sidney",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sidney, IA

Sources for this page

Verify at the official NPI Registry.