NPIMap

Organization Active NPI

Madrid Family Practice Clinic

  • Family Nurse Practitioner
  • Madrid, IA
National Provider Identifier
1508882705
Registry record updated Jul 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
MADRID FAMILY PRACTICE CLINIC
Practice address
623 W North St
Madrid, IA 50156-1023
Phone
(515) 795-4300
Fax
(515) 433-8905
NPI assigned
Jul 14, 2006
Last updated
Jul 1, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2026

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

Authorized official

Name
Mikaela Kienitz
Title
Ceo
Phone
(515) 432-3140

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X IA
Family Nurse Practitioner 363LF0000X Primary

Addresses

Primary practice location

623 W North St
Madrid, IA 50156-1023

Mailing address

623 W North St
Madrid, IA 50156-1023
Phone (515) 795-4300

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mfpc@bch.converge.direct

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040414001240 IA Part B Supplier - Clinic/Group Practice 6507850146 Receives reassigned benefits from 11 practitioners
Practice locations: Madrid, IA
O20150702001243 IA Part A Provider - Rural Health Clinic 6507850146 Practice locations: Madrid, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508882705. Details of each certification follow.

Rural health clinic certification: CCN 168574

Legal name
MADRID FAMILY PRACTICE CLINIC
Doing business as
MADRID FAMILY PRACTICE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 19, 2016
Last certification
Apr 17, 2025
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
623 W North St
Madrid, IA 50156-1023
Related CCNs
161372

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

National Provider Directory

National Provider Directory

Locations

1015 Union St
Ste 100
Boone, IA 50036

Interoperability endpoints

  • Direct secure messaging: mfpc@cynchealthdsm.org

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Emily McCarty Individual Corporate OfficerBoard Member Oct 1, 2019
Catherine E Wetzeler Individual Corporate OfficerBoard Member Jan 1, 2022
Brian Reimers Individual Corporate Officer Jan 28, 2021
Troy Thompson Individual Corporate OfficerBoard Member Jan 1, 2013
Mikaela Kienitz Individual Corporate OfficerCeo Jan 2, 2023
W-2 Managing EmployeeCeo Jan 2, 2023
Operational/Managerial ControlCeo Jan 2, 2023
Christopher J Torres Individual Corporate OfficerCfo Jun 24, 2024
W-2 Managing EmployeeCfo Jun 24, 2024
Meredith Nerem Individual Corporate Officer Mar 27, 2014
Lisa Kobernusz Individual Corporate Officer Mar 27, 2014
Robert Getschman Individual Corporate OfficerBoard Member Jan 1, 2017

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782864000000",
    "number": "1508882705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "623 W NORTH ST",
            "city": "MADRID",
            "state": "IA",
            "postal_code": "501561023",
            "telephone_number": "515-795-4300",
            "fax_number": "515-433-8905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 W NORTH ST",
            "city": "MADRID",
            "state": "IA",
            "postal_code": "501561023",
            "telephone_number": "515-795-4300",
            "fax_number": "515-433-8905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADRID FAMILY PRACTICE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2026-07-01",
        "certification_date": "2026-07-01",
        "status": "A",
        "authorized_official_last_name": "KIENITZ",
        "authorized_official_first_name": "MIKAELA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "515-432-3140"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mfpc@bch.converge.direct",
            "affiliation": "N",
            "address_1": "623 W North St",
            "city": "Madrid",
            "state": "IA",
            "country_code": "US",
            "postal_code": "501561023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madrid, IA

Sources for this page

Verify at the official NPI Registry.