NPIMap

Organization Active NPI

Catholic Health Initiatives-Iowa Corp

Doing business as MercyOne Clive Pharmacy

  • Community/Retail Pharmacy
  • Clive, IA
National Provider Identifier
1619952926
Registry record updated Oct 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
1193 Issued in IA
Legal business name
CATHOLIC HEALTH INITIATIVES-IOWA CORP
Doing business as
MercyOne Clive Pharmacy
Practice address
1601 NW 114TH St
Suite 234
Clive, IA 50325-7007
Phone
(515) 222-7979
Fax
(515) 222-7976
NPI assigned
Dec 8, 2005
Last updated
Oct 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2024

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

Authorized official

Name
Kurt Andersen
Title
President
Phone
(515) 358-9200

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X 1193 IA Primary

Addresses

Primary practice location

1601 NW 114TH St
Suite 234
Clive, IA 50325-7007

Mailing address

1601 NW 114TH St
Suite 234
Clive, IA 50325-7007
Phone (515) 222-7979

Other names 1

  • MercyOne Clive Pharmacy Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930011213 IA DME Supplier - Pharmacy 5698683142 Practice locations: Clive, IA
O20130716000153 IA Part B Supplier - Pharmacy 5698683142 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clive, IA; Ankeny, IA; Des Moines, IA

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 3

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

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Mercyone Clive Pharmacy1601 NW 114TH St, Clive, IA 50325-7007(515) 222-7979 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Dec 6, 2004

National Provider Directory

National Provider Directory
Tax ID family
Catholic Health Initiatives - Iowa Corp15 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

Ownership & related parties

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mercyone Centerville Medical CenterCenterville, IA, CCN 161377 Hospital 5% Or Greater Indirect Ownership Interest (100%) Sep 1, 2022
Mercyone Centerville Medical CenterCenterville, IA, CCN 16Z377 Hospital 5% Or Greater Indirect Ownership Interest (100%) Sep 1, 2022
Mercyone Newton Medical CenterNewton, IA, CCN 160032 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Mercyone Newton Medical Center-Swing BedNewton, IA, CCN 16U032 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Mercy Rehabilitation HospitalClive, IA, CCN 163025 Hospital 5% Or Greater Direct Ownership Interest (51%) Apr 26, 2016
Clive Behavioral HealthClive, IA, CCN 164007 Hospital 5% Or Greater Direct Ownership Interest (48%) May 28, 2018
Mercyone Centerville Medical ClinicCenterville, IA, CCN 168533 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022

Owned or controlled facilities with NPI records 7

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

NPI Registry JSON

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

{
    "created_epoch": "1134000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729468800000",
    "number": "1619952926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 NW 114TH ST",
            "address_2": "SUITE 234",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503257007",
            "telephone_number": "515-222-7979",
            "fax_number": "515-222-7976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 NW 114TH ST",
            "address_2": "SUITE 234",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503257007",
            "telephone_number": "515-222-7979",
            "fax_number": "515-222-7976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CATHOLIC HEALTH INITIATIVES-IOWA CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-08",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A",
        "authorized_official_last_name": "ANDERSEN",
        "authorized_official_first_name": "KURT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "515-358-9200"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "1193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MercyOne Clive Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clive, IA

Sources for this page

Verify at the official NPI Registry.