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Shenandoah Medical Center

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

NPI 1497150825 · NPPES record last updated Jul 28, 2026

Key facts

NPI
1497150825
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
730065H (IA)
Legal business name
SHENANDOAH MEDICAL CENTER
Practice address
802 Illinois St
Sidney, IA 51652-8028
Phone
(712) 374-6005
Fax
(712) 374-3100
NPI assigned
Oct 28, 2014
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 6

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

Owned or controlled facilities with NPI records 4

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

Other NPIs with the same Medicare PAC ID 6

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

Corporate family (same tax ID) 14

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.

Facilities with the same owner 4

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

Practitioners 52

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

View all 52

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IA

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
Corporation · Non-profit
Incorporated
Mar 30, 1978 in IA
Enrollment address
802 Illinois St
Sidney, IA 51652-8028
Related CCNs
161366

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 Director
Boaed Member		 Aug 1, 2012 100%
Matthew R Sells
Individual 		Corporate Officer
Cfo		 Apr 10, 2017 100%
W-2 Managing Employee
Cfo		 Jul 28, 2014 100%
Alissa McGinnis
Individual 		Corporate Director
Board Member		 Jul 1, 2012 100%
Edward J Kloberdanz
Individual 		Corporate Director
Board Member		 Jul 1, 2012 100%
Shenandoah Medical Center
Organization · Shenandoah, IA
Non-profit 		5% Or Greater Direct Ownership Interest Dec 1, 2014 100%

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

Medicare enrollment records

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

National Provider Directory

Tax ID family
Shenandoah Memorial Hospi (15 organizations share this tax ID)

Specialties & licenses

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

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

  • Shenandoah Physicians Clinic-Sidney Doing business as

Other providers in Sidney, IA

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

Sources for this page

Verify at the official NPI Registry.