NPIMap

Organization Active NPI

Story County Hospital

  • Rural Health Clinic/Center
  • Nevada, IA
National Provider Identifier
1508390352
Registry record updated Apr 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
STORY COUNTY HOSPITAL
Practice address
640 S 19TH St Ste 100
Nevada, IA 50201-2902
Phone
(515) 382-5413
Fax
(515) 382-7107
NPI assigned
Apr 19, 2017
Organization subpart
Yes
Parent organization
STORY COUNTY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 19, 2017

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

Authorized official

Name
Nathan D Thompson
Title
Ceo
Phone
(515) 382-2111

Specialties & licenses 1

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

Addresses

Primary practice location

640 S 19TH St Ste 100
Nevada, IA 50201-2902

Mailing address

640 S 19TH St Ste 100
Nevada, IA 50201-2902
Phone (515) 382-5413

Other names 1

  • STORY MEDICAL CLINIC - NEVADA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170425001202 IA Part A Provider - Rural Health Clinic 0547153884 Practice locations: Nevada, IA

Rural health clinic certification: CCN 168594

Legal name
STORY COUNTY HOSPITAL
Doing business as
STORY MEDICAL CLINIC - NEVADA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 16, 2017
Last certification
Aug 16, 2017
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
640 S 19TH St
Ste 100
Nevada, IA 50201-2902
Related CCNs
161333

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
John Bergseng DO6 organizations share this tax ID, including this one
Part of
John Bergseng DO

Other organizations with this tax ID 5

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

Locations

640 S 19th St
#100
Nevada, IA 50201

640 S 19th St
Ste 100
Nevada, IA 50201
Phone (515) 382-5413

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Gaylan G Scofield Individual Corporate Director Jan 1, 2004
Central Iowa Hospital Corporation Organization, Des Moines, IA Corporation, Non-profit Operational/Managerial Control Feb 1, 2013
Patrick J Sheets Individual Corporate Officer Jan 1, 2023
Corporate Director Jan 1, 2007
David F Anderson Individual Corporate Director Dec 13, 1990
Arthur P Check Individual W-2 Managing EmployeeMD; Aug 16, 2017
Operational/Managerial ControlMedical Director Aug 16, 2017
Pamela E Cain Individual Corporate Officer Jan 1, 2024
Corporate Director Jan 3, 2023
Brenda L Smith Individual W-2 Managing EmployeeAd;Director of Clinics Oct 11, 2022
Operational/Managerial ControlDirector of Clinics Oct 11, 2022
Jane D Ramthun Individual Corporate OfficerCfo May 24, 2020
W-2 Managing EmployeeCfo Sep 29, 2008
Operational/Managerial ControlCfo Sep 29, 2008
Elizabeth G Hertz Individual Corporate Officer Jan 1, 2025
Corporate Director Jan 1, 2007
Nathan D Thompson Individual Contracted Managing EmployeeCeo Sep 12, 2015
Corporate OfficerCeo Aug 9, 2016
Operational/Managerial ControlCeo Sep 12, 2015
Tiffany B Thompson Individual Corporate Director Jan 3, 2023
Michelle L Fullerton Individual Corporate Director Apr 3, 2025

Owners & managing parties with NPI records 7

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

Facilities with the same owner 22

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

View all 22

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492560000000",
    "number": "1508390352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 S 19TH ST STE 100",
            "city": "NEVADA",
            "state": "IA",
            "postal_code": "502012902",
            "telephone_number": "515-382-5413",
            "fax_number": "515-382-7107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 S 19TH ST STE 100",
            "city": "NEVADA",
            "state": "IA",
            "postal_code": "502012902",
            "telephone_number": "515-382-5413",
            "fax_number": "515-382-7107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STORY COUNTY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STORY COUNTY HOSPITAL",
        "enumeration_date": "2017-04-19",
        "last_updated": "2017-04-19",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "515-382-2111"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STORY MEDICAL CLINIC - NEVADA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "STORY MEDICAL CLINIC - NEVADA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nevada, IA

Sources for this page

Verify at the official NPI Registry.