NPIMap

Organization Active NPI

River Hills Community Health Center Inc

Doing business as RHCHC-Jefferson County Clinic

  • Federally Qualified Health Center (FQHC)
  • Fairfield, IA
National Provider Identifier
1518630102
Registry record updated Jul 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RIVER HILLS COMMUNITY HEALTH CENTER INC
Doing business as
RHCHC-Jefferson County Clinic
Practice address
2000 S Main St
Fairfield, IA 52556-9572
Phone
(641) 683-5773
Fax
(641) 226-5759
NPI assigned
Jul 29, 2021
Last updated
Jul 29, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
RIVER HILLS COMMUNITY HEALTH CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 29, 2021

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

Authorized official

Name
Kim Grove
Title
Revenue Cycle Director
Phone
(641) 684-6896

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2000 S Main St
Fairfield, IA 52556-9572

Mailing address

PO Box 458
Ottumwa, IA 52501-0458
Phone (641) 684-6896

Other names 1

  • RHCHC-Jefferson County Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210901001686 IA Part A Provider - Federally Qualified Health Center (FQHC) 8426076225 Practice locations: Fairfield, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1518630102. Details of each certification follow.

Federally qualified health center certification: CCN 161002

Legal name
RIVER HILLS COMMUNITY HEALTH CENTER INC
Doing business as
RHCHC-JEFFERSON COUNTY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 13, 2021
Last certification
Oct 13, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
2000 S Main St
Fairfield, IA 52556-9572

Other NPIs with the same Medicare PAC ID 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2232948River Hills Community Health Center2000 South Main Street, Fairfield, IA 52556Certificate of waiverAug 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
River Hills Community H21 organizations share this tax ID, including this one
Part of
River Hills Community H

Other organizations with this tax ID 20

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

View all 20

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
Mariamma T Mukkada Individual Corporate Officer Feb 1, 2010
Shea Greiner Individual Corporate Officer Mar 1, 2018
Thomas Shafer Individual Corporate Officer Sep 3, 2019
Rachelle Mitchell-Shadduck Individual Corporate Officer Mar 1, 2018
Joshua Stevens Individual Corporate Officer Sep 3, 2019
Jacquelyn F Pope Individual Corporate OfficerBoard Member Jul 1, 2012
Kimberly Grove Individual Corporate DirectorRevenue Cycle Director Oct 13, 2004
W-2 Managing EmployeeRevenue Cycle Director Oct 13, 2004
Brenda Hostetler Individual Corporate Officer Mar 1, 2008
Gina M Throckmorton Individual Corporate DirectorCoo Oct 13, 2003
Diana Hughell Individual Corporate Officer Sep 3, 2019
Michelle H Swanstrom Individual Corporate Officer Feb 1, 2010
Richard Johnson Individual Corporate DirectorCeo Jun 16, 2005

NPI Registry JSON

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

{
    "created_epoch": "1627516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627516800000",
    "number": "1518630102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 458",
            "city": "OTTUMWA",
            "state": "IA",
            "postal_code": "525010458",
            "telephone_number": "641-684-6896",
            "fax_number": "641-226-5759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 S MAIN ST",
            "city": "FAIRFIELD",
            "state": "IA",
            "postal_code": "525569572",
            "telephone_number": "641-683-5773",
            "fax_number": "641-226-5759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER HILLS COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RIVER HILLS COMMUNITY HEALTH CENTER INC",
        "enumeration_date": "2021-07-29",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-01",
        "status": "A",
        "authorized_official_last_name": "GROVE",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "641-684-6896"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RHCHC-Jefferson County Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfield, IA

Sources for this page

Verify at the official NPI Registry.