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Organization Active NPI

Shenandoah Medical Center

  • Rural Health Clinic/Center
  • Tabor, IA
National Provider Identifier
1508487547
Registry record updated Jul 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SHENANDOAH MEDICAL CENTER
Practice address
400 Main St
Tabor, IA 51653-2076
Phone
(712) 246-7245
NPI assigned
Apr 30, 2020
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Matthew Sells
Title
Ceo
Phone
(712) 246-7160

Owners & managing parties with NPI records 7

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

Owned or controlled facilities with NPI records 4

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

Other NPIs on the same Medicare enrollment 6

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

Other NPIs with the same Medicare PAC ID 6

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

Facilities with the same owner 4

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

Practitioners 52

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

View all 52

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

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
This NPI is an additional NPI on the enrollment
Practice locations: Essex, IA; Hamburg, IA; Red Oak, IA; Shenandoah, IA; Sidney, IA; Tabor, IA
O20200527001531 IA Part A Provider - Rural Health Clinic 9436063237 Practice locations: Tabor, IA

Rural health clinic certification: CCN 168645

Legal name
SHENANDOAH MEDICAL CENTER
Doing business as
SHENANDOAH PHYSCIANS CLINIC-TABOR
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 15, 2020
Last certification
Oct 15, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
400 Main St
Tabor, IA 51653-2076
Related CCNs
161366

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

All disclosed owners & managing parties 11

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
Brianna Sorensen Individual Corporate DirectorDirectors Mar 1, 2020
Roger D Jones Individual Corporate DirectorSecretary/Treasurer Mar 1, 2020
Dennis Grebert Individual Corporate DirectorVice Chairman Mar 1, 2020
Heather Lee Babe Individual Corporate DirectorDirector Mar 1, 2020
Matthew R Sells Individual Corporate OfficerCeo Mar 1, 2020
Corporate DirectorCeo Mar 1, 2020
W-2 Managing EmployeeCeo Mar 1, 2020
Alissa McGinnis Individual Corporate DirectorChairman Mar 1, 2020
Bruce Baldwin Individual Corporate DirectorDirector Mar 1, 2020
Edward J Kloberdanz Individual Corporate DirectorDirector Mar 1, 2020
Stephen Ruzek Individual Corporate DirectorDirectors Mar 1, 2020
Thomas Steinolfson Individual Corporate DirectorDirector Mar 1, 2020
Shenandoah Medical Center Organization, Shenandoah, IA Non-profit 5% Or Greater Direct Ownership Interest Jun 1, 2020 100%

All facility ownership & control disclosures 4

Medicare enrollment files

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

National Provider Directory

National Provider Directory
Tax ID family
Shenandoah Memorial Hospi15 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

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

400 Main St
Tabor, IA 51653-2076

Mailing address

300 Pershing Ave
Shenandoah, IA 51601-2355
Phone (712) 246-7400

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 28, 2026.

{
    "created_epoch": "1588204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785196800000",
    "number": "1508487547",
    "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": "712-246-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MAIN ST",
            "city": "TABOR",
            "state": "IA",
            "postal_code": "516532076",
            "telephone_number": "712-246-7245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHENANDOAH MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-30",
        "last_updated": "2026-07-28",
        "certification_date": "2026-07-28",
        "status": "A",
        "authorized_official_last_name": "SELLS",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-246-7160"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tabor, IA

Sources for this page

Verify at the official NPI Registry.