NPIMap

Organization Active NPI

Sioux Center Health

Doing business as Medical Clinic

  • Family Medicine Physician
  • Sioux Center, IA
National Provider Identifier
1558494138
Registry record updated Apr 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SIOUX CENTER HEALTH
Doing business as
Medical Clinic
Practice address
1101 9 St SE
Sioux Center, IA 51250-2501
Phone
(712) 722-2609
Fax
(712) 722-4325
NPI assigned
Mar 13, 2007
Last updated
Apr 20, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SIOUX CENTER HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2023

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

Authorized official

Name
Crystal Richter
Title
Cfo
Phone
(712) 722-8153

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1101 9 St SE
Sioux Center, IA 51250-2501

Mailing address

1101 9 St SE
Sioux Center, IA 51250-2501
Phone (712) 722-2609

Other identifiers 1

IdentifierTypeStateIssuer
0429316MedicaidIA

Other names 1

  • Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040224001315 IA Part B Supplier - Clinic/Group Practice 9032027495 Receives reassigned benefits from 55 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hull, IA; Sioux Center, IA; Lemars, IA; Hawarden, IA

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Part of
Sioux Center Health

Practitioners & affiliated clinicians

Practitioners 11

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": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681948800000",
    "number": "1558494138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 9 ST SE",
            "city": "SIOUX CENTER",
            "state": "IA",
            "postal_code": "512502501",
            "telephone_number": "712-722-2609",
            "fax_number": "712-722-4325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 9 ST SE",
            "city": "SIOUX CENTER",
            "state": "IA",
            "postal_code": "512502501",
            "telephone_number": "712-722-2609",
            "fax_number": "712-722-4325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIOUX CENTER HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SIOUX CENTER HEALTH",
        "enumeration_date": "2007-03-13",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A",
        "authorized_official_last_name": "RICHTER",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "712-722-8153"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0429316",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux Center, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.