NPIMap

Organization Active NPI

Pella Regional Health Center

  • Rural Health Clinic/Center
  • Prairie City, IA
National Provider Identifier
1497413637
Registry record updated Dec 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PELLA REGIONAL HEALTH CENTER
Practice address
404 East 2ND Street
Prairie City, IA 50228-8829
Phone
(515) 994-2617
Fax
(515) 994-2365
NPI assigned
Dec 6, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2022

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

Authorized official

Name
Robert D. Kroese
Title
Ceo
Phone
(641) 628-6604

Specialties & licenses 1

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

Addresses

Primary practice location

404 East 2ND Street
Prairie City, IA 50228-8829

Mailing address

404 East 2ND Street
Prairie City, IA 50228-8829
Phone (515) 994-2617

Other names 1

  • Prairie City Medical Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address prhc@direct.pellahealth.kobledirect.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211216000222 IA Part A Provider - Rural Health Clinic 9931005873 Practice locations: Prairie City, IA

Rural health clinic certification: CCN 168660

Legal name
PELLA REGIONAL HEALTH CENTER
Doing business as
PRAIRIE CITY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 21, 2022
Last certification
Jul 21, 2022
Ownership / control type
2B
Organization structure
OtherNon-profit
Incorporated
Jun 1, 1958 in IA
Enrollment address
404 E 2ND St
Prairie City, IA 50228-8829
Related CCNs
161367

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

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Pella HLTH Ctr Med Clin13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Robert D Kroese Individual Corporate OfficerChief Executive Officer Dec 1, 1992
W-2 Managing EmployeeChief Executive Officer Dec 1, 1992 100%
Chad Loren Huyser Individual Corporate DirectorBoard Director at Pella Regional Feb 1, 2019 9.1%
James M Brandl Individual Corporate DirectorVice President of the Board at P Jan 1, 2018 9.1%
Stephen Ambrose Barnes Individual Corporate DirectorBoard Director at Pella Regional Jan 1, 2020 9.1%
Bruce Alan Heifner Individual Corporate OfficerChief Financial Officer Feb 9, 2015
W-2 Managing EmployeeChief Financial Officer Feb 9, 2015 100%
Randall C Stravers Individual Corporate DirectorBoard Chairman at Pella Regional Jan 1, 2017 9.1%
Rodney O Braun Individual Corporate DirectorBoard Director at Pella Regional Jan 1, 2013 9.1%
Michael P Morgan Individual Corporate DirectorBoard Director at Pella Regional Mar 1, 2014 9.1%
Mary Lou Glendening Individual Corporate DirectorBoard Secretary at Pella Regiona Jan 1, 2015 9.1%
Leslie Johnston Individual Corporate DirectorBoard Director at Pella Regional Apr 1, 2020 9.1%
Craig Allen Wittenberg Individual Corporate DirectorMedical Director at Pella Region Feb 9, 2002 9.1%
Richard Dale Posthuma Individual Corporate DirectorBoard Director at Pella Regional Jul 1, 2019 9.1%
Pella Regional Health Center Organization, Pella, IA Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2017 100%
5% Or Greater Security Interest Jul 1, 2017 100%
Operational/Managerial Control Jul 1, 2017 100%
Travis Turnbull Individual Corporate DirectorBoard Treasurer at Pella Regiona Sep 1, 2019 9.1%

Owners & managing parties with NPI records 12

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

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Pella Regional Health CenterPella, IA, CCN 161367 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 29, 2013
Aug 29, 2013
Pella Regional Health CenterPella, IA, CCN 16Z367 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 29, 2013
Nov 15, 2007
Pella Regional Home Health AgencyPella, IA, CCN 167220 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 21, 2007
Jan 1, 1994
Hospice of Pella, the Comfort HousePella, IA, CCN 161538 Hospice 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 19, 1996
Sep 19, 1996
Sully Family Health CenterSully, IA, CCN 163455 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 1, 1996
Jan 1, 1996
Ottumwa Medical ClinicOttumwa, IA, CCN 168562 Rural health clinic Operational/Managerial Control (100%) Aug 1, 2012

Owned or controlled facilities with NPI records 6

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

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Practitioners 96

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

View all 96

NPI Registry JSON

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

{
    "created_epoch": "1638748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670284800000",
    "number": "1497413637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 EAST 2ND STREET",
            "city": "PRAIRIE CITY",
            "state": "IA",
            "postal_code": "502288829",
            "telephone_number": "515-994-2617",
            "fax_number": "515-994-2365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 EAST 2ND STREET",
            "city": "PRAIRIE CITY",
            "state": "IA",
            "postal_code": "502288829",
            "telephone_number": "515-994-2617",
            "fax_number": "515-994-2365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELLA REGIONAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-06",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A",
        "authorized_official_last_name": "KROESE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "641-628-6604"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "prhc@direct.pellahealth.kobledirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "404 East 2nd Street",
            "city": "Prairie City",
            "state": "IA",
            "country_code": "US",
            "postal_code": "502288829",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Prairie City Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Prairie City Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prairie City, IA

Sources for this page

Verify at the official NPI Registry.