NPIMap

Organization Active NPI

Pella Regional Health Center

Doing business as Ottumwa Medical Clinic

  • Rural Health Clinic/Center
  • Ottumwa, IA
National Provider Identifier
1508101221
Registry record updated Dec 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
630165H Issued in IA
Legal business name
PELLA REGIONAL HEALTH CENTER
Doing business as
Ottumwa Medical Clinic
Practice address
920 N Quincy Ave
Ottumwa, IA 52501-3866
Phone
(641) 455-5200
Fax
(641) 455-5150
NPI assigned
Dec 6, 2012
Last updated
Dec 6, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
PELLA REGIONAL HEALTH CENTERAs reported in NPPES

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 630165H IA Primary

Addresses

Primary practice location

920 N Quincy Ave
Ottumwa, IA 52501-3866

Mailing address

920 N Quincy Ave
Ottumwa, IA 52501-3866
Phone (641) 455-5200

Other names 1

  • Ottumwa 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
O20140917001382 IA Part A Provider - Rural Health Clinic 9931005873 Practice locations: Ottumwa, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508101221. Details of each certification follow.

Rural health clinic certification: CCN 168562

Legal name
PELLA REGIONAL HEALTH CENTER
Doing business as
OTTUMWA MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 10, 2014
Last certification
Sep 19, 2017
Ownership / control type
2B
Organization structure
OtherNon-profit
Incorporated
Jun 1, 1958 in IA
Enrollment address
920 N Quincy Avenue
Ottumwa, IA 52501-3866
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 Medical Clinic13 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 OfficerHas Daily Oversight But Governed Jan 1, 1993
W-2 Managing EmployeeCeo of Pella Regional Health Cen Sep 4, 2014 100%
Chad Loren Huyser Individual Corporate DirectorBoard Director Feb 1, 2019 9.1%
James M Brandl Individual Corporate DirectorVice President Jan 1, 2018 9.1%
Stephen Ambrose Barnes Individual Corporate DirectorBoard Director 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
Randall C Stravers Individual Corporate DirectorBoard Chairman Jan 1, 2017 9.1%
Rodney O Braun Individual Corporate DirectorBoard Director Jan 15, 2013 9.1%
Michael P Morgan Individual Corporate DirectorBoard Director Sep 4, 2014 9.1%
Mary Lou Glendening Individual Corporate DirectorBoard Secretary Jan 1, 2015 9.1%
Leslie Johnston Individual Corporate DirectorBoard Director 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 Jul 1, 2019 9.1%
Pella Regional Health Center Organization, Pella, IA Non-profit Operational/Managerial Control Aug 1, 2012 100%
Travis Turnbull Individual Corporate DirectorBoard Treasurer 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
Prairie City Medical ClinicPrairie City, IA, CCN 168660 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
5% Or Greater Security Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 2017
Jul 1, 2017
Jul 1, 2017

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 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1354752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670284800000",
    "number": "1508101221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 N QUINCY AVE",
            "city": "OTTUMWA",
            "state": "IA",
            "postal_code": "525013866",
            "telephone_number": "641-455-5200",
            "fax_number": "641-455-5150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 N QUINCY AVE",
            "city": "OTTUMWA",
            "state": "IA",
            "postal_code": "525013866",
            "telephone_number": "641-455-5200",
            "fax_number": "641-455-5150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELLA REGIONAL HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PELLA REGIONAL HEALTH CENTER",
        "enumeration_date": "2012-12-06",
        "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": "IA",
            "license": "630165H",
            "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": "920 N Quincy Ave",
            "city": "Ottumwa",
            "state": "IA",
            "country_code": "US",
            "postal_code": "525013866",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Ottumwa Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ottumwa Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ottumwa, IA

Sources for this page

Verify at the official NPI Registry.