NPIMap

Organization Active NPI

Shenandoah Medical Center

  • Certified Registered Nurse Anesthetist
  • Shenandoah, IA
National Provider Identifier
1497810972
Registry record updated Oct 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
730065H Issued in IA
Legal business name
SHENANDOAH MEDICAL CENTER
Practice address
300 Pershing Ave
Shenandoah, IA 51601-2355
Phone
(712) 246-1230
Fax
(712) 246-7357
NPI assigned
Dec 26, 2006
Last updated
Oct 25, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2012

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

Authorized official

Name
Karen Cole
Title
Ceo
Phone
(712) 246-1230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 367500000X 730065H IA Primary

Addresses

Primary practice location

300 Pershing Ave
Shenandoah, IA 51601-2355

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040209000347 IA Part B Supplier - Clinic/Group Practice 9436063237 Receives reassigned benefits from 90 practitioners
6 other NPIs on this enrollment
Practice locations: Essex, IA; Hamburg, IA; Red Oak, IA; Shenandoah, IA; Sidney, IA; Tabor, IA

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Shenandoah Medical Center15 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 facility ownership & control disclosures 5

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 Physicians Clinic-SidneySidney, IA, CCN 168569 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2014
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 5

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

Practitioners & affiliated clinicians

Practitioners 92

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 92

NPI Registry JSON

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351123200000",
    "number": "1497810972",
    "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": "300 PERSHING AVE",
            "city": "SHENANDOAH",
            "state": "IA",
            "postal_code": "516012355",
            "telephone_number": "712-246-1230",
            "fax_number": "712-246-7357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHENANDOAH MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2012-10-25",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-246-1230"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IA",
            "license": "730065H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shenandoah, IA

Sources for this page

Verify at the official NPI Registry.