NPIMap

Organization Active NPI

Madison County Memorial Hospital

  • Rural Health Clinic/Center
  • Earlham, IA
National Provider Identifier
1497810097
Registry record updated Aug 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MADISON COUNTY MEMORIAL HOSPITAL
Practice address
137 W 1St St
Earlham, IA 50072-7717
Phone
(515) 758-2907
NPI assigned
Dec 26, 2006
Organization subpart
Yes
Parent organization
MADISON COUNTY MEMORIAL HOSPITALAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Marcia L Hendricks
Title
Ceo
Phone
(515) 462-2373

Owners & managing parties with NPI records 1

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

Other NPIs with the same Medicare PAC ID 4

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

Facilities with the same owner 98

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

View all 98

Practitioners 45

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

View all 45

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0947407Earlham Medical Clinic137 W 1St St, Earlham, IA 50072Certificate of waiverMar 15, 2028

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030919000024 IA Part A Provider - Rural Health Clinic 6002727179 Practice locations: Earlham, IA

Rural health clinic certification: CCN 163486

Legal name
MADISON COUNTY MEMORIAL HOSPITAL
Doing business as
EARLHAM MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 1, 2002
Last certification
Feb 18, 2021
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
137 W 1St St
Earlham, IA 50072-7717
Related CCNs
161326

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

All disclosed owners & managing parties 12

Medicare enrollment files

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

NameRoleSinceShare
Elisa L Perry Individual W-2 Managing EmployeeAd;Clinic Director Jun 29, 2017
Operational/Managerial ControlClinic Director Jun 29, 2017
Jared McDonald Individual Corporate Officer Sep 26, 2019
Corporate Director May 28, 2015
Sarah C. Nigg Individual Corporate Director May 9, 2024
Brian K Gibson Individual Corporate Officer Dec 1, 2022
Corporate Director Dec 14, 2021
Mercy Health Network Inc Organization, Clive, IA Corporation, Management services company, Non-profit Operational/Managerial Control Nov 1, 2012
Julie R Plant Individual Corporate Director Jan 22, 2026
Jacque Mohs Individual Corporate Officer Jan 1, 2021
Corporate Director Jul 23, 2015
Sharon Carlson Individual Corporate Director Jan 26, 2017
Ambrose B Munro Individual W-2 Managing EmployeeMD; Mar 1, 2026
Operational/Managerial ControlMedical Director Mar 1, 2026
Audra C Ford Individual Corporate OfficerCfo Sep 2, 2024
W-2 Managing EmployeeCfo Sep 2, 2024
Operational/Managerial ControlCfo Sep 2, 2024
Gary R Van Dyke Individual Corporate Director Jan 1, 2025
Marcia L. Hendricks Individual Contracted Managing EmployeeCeo Sep 8, 2003
Corporate OfficerCeo Jun 23, 2016
Operational/Managerial ControlCeo Sep 8, 2003

National Provider Directory

National Provider Directory
Tax ID family
Madison County Memorial6 organizations share this tax ID, including this one
Part of
Madison County Memorial

Other organizations with this tax ID 5

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

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

137 W 1St St
Earlham, IA 50072-7717

Mailing address

300 W Hutchings St
Winterset, IA 50273-2104
Phone (515) 462-2373

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
0634931MedicaidIA
63486OtherIABCBS

Other names 1

NPPES NPI Registry
  • Earlham Medical Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 12, 2026.

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786492800000",
    "number": "1497810097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W HUTCHINGS ST",
            "city": "WINTERSET",
            "state": "IA",
            "postal_code": "502732104",
            "telephone_number": "515-462-2373",
            "fax_number": "515-462-5213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "137 W 1ST ST",
            "city": "EARLHAM",
            "state": "IA",
            "postal_code": "500727717",
            "telephone_number": "515-758-2907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MADISON COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2006-12-26",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "515-462-2373"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0634931",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "63486",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Earlham Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Earlham, IA

Sources for this page

Verify at the official NPI Registry.