NPIMap

Organization Active NPI

Palmer Lutheran Health Center, Inc.

Doing business as Gundersen Palmer Lutheran Hospital and Clinics

  • Critical Access Hospital
  • West Union, IA
National Provider Identifier
1598765398
Registry record updated Nov 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
330070H Issued in IA
Legal business name
PALMER LUTHERAN HEALTH CENTER, INC.
Doing business as
Gundersen Palmer Lutheran Hospital and Clinics
Practice address
112 Jefferson Street
West Union, IA 52175
Phone
(563) 422-3811
Fax
(563) 422-9754
NPI assigned
Jul 22, 2005
Last updated
Nov 29, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 29, 2018

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

Authorized official

Name
Patrice Kuennen
Title
Ceo
Phone
(563) 422-3811

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 330070H IA Primary

Addresses

Primary practice location

112 Jefferson Street
West Union, IA 52175

Mailing address

112 Jefferson Street
West Union, IA 52175
Phone (563) 422-3811

Other identifiers 3

IdentifierTypeStateIssuer
0601294MedicaidIA
601294MedicaidIA
60129OtherIABLUE CROSS PROVIDER NUMBE

Other names 1

  • Gundersen Palmer Lutheran Hospital and Clinics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061104000164 IA Part A Provider - Critical Access Hospital 4284544255 Receives reassigned benefits from 89 practitioners
Practice locations: West Union, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598765398. Details of each certification follow.

Hospital certification: CCN 161316

Legal name
PALMER LUTHERAN HEALTH CENTER INC
Doing business as
GUNDERSEN PALMER LUTHERAN HOSPITAL AND CLINICS
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Mar 1, 2001
Last certification
Feb 5, 2025
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
112 Jefferson St
West Union, IA 52175-1022

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

Other NPIs with the same Medicare PAC ID 9

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Gundersen Palmer Lutheran Hospital and ClinicsCCN 161316 · All quality measures
Overall star rating
5 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Palmer Lutheran HLTH12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

112 Jefferson St
Ste A
West Union, IA 52175

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Rachel Kathryn Albrecht Individual Corporate Director Jan 1, 2023
Kristi M Flack Individual Corporate Director Jan 24, 2018
Thomas Tornstrom Individual Corporate DirectorBoard Member Apr 1, 2022
Nicole Havenstrite Individual Corporate DirectorBoard Member Jan 1, 2024
Patrice R Kuennen Individual Corporate Officer Oct 8, 2018
W-2 Managing Employee Oct 8, 2018
Brenda S Moser Individual Corporate OfficerFinance Administrator Jan 1, 2025
Bellin Gundersen Health System Inc Organization, La Crosse, WI Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Nov 30, 2022 100%
Operational/Managerial Control Nov 30, 2022 100%
Jodi Webb Individual Corporate DirectorBoard Member Nov 7, 2024
Gundersen Lutheran Health System Inc Organization, La Crosse, WI Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 31, 2015 100%
Operational/Managerial Control Jul 31, 2015
Charles L Johnson Individual Corporate Director Jan 21, 2020

Facilities with the same owner 49

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

View all 49

Practitioners & affiliated clinicians

Practitioners 90

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 90

Affiliated clinicians 124

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 124

NPI Registry JSON

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543449600000",
    "number": "1598765398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 JEFFERSON STREET",
            "city": "WEST UNION",
            "state": "IA",
            "postal_code": "52175",
            "telephone_number": "563-422-3811",
            "fax_number": "563-422-9754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 JEFFERSON STREET",
            "city": "WEST UNION",
            "state": "IA",
            "postal_code": "52175",
            "telephone_number": "563-422-3811",
            "fax_number": "563-422-9754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMER LUTHERAN HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.",
        "enumeration_date": "2005-07-22",
        "last_updated": "2018-11-29",
        "status": "A",
        "authorized_official_last_name": "KUENNEN",
        "authorized_official_first_name": "PATRICE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "563-422-3811"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IA",
            "license": "330070H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0601294",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "601294",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "60129",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gundersen Palmer Lutheran Hospital and Clinics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gundersen Palmer Lutheran Hospital and Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Union, IA

Sources for this page

Verify at the official NPI Registry.