NPIMap

Organization Active NPI

Hegg Memorial Hospital

Doing business as Hegg Medical Clinic

  • Family Medicine Physician
  • Rock Valley, IA
National Provider Identifier
1629023429
Registry record updated Aug 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HEGG MEMORIAL HOSPITAL
Doing business as
Hegg Medical Clinic
Practice address
1202 21St Avenue
Rock Valley, IA 51247-1445
Phone
(712) 476-8100
Fax
(712) 476-8190
NPI assigned
May 23, 2006
Last updated
Aug 10, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2009

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

Authorized official

Name
Mrs. Valerie Ladd Loudenback
Title
Clinic Manager
Phone
(712) 476-8150

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X IA Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1202 21St Avenue
Rock Valley, IA 51247-1445

Mailing address

2121 Hegg Dr
Rock Valley, IA 51247-1445
Phone (712) 476-8100

Other identifiers 2

IdentifierTypeStateIssuer
0201089MedicaidIA
0129528MedicaidIA

Other names 1

  • Hegg Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040407001457 IA Part B Supplier - Clinic/Group Practice 5193718757 Receives reassigned benefits from 98 practitioners
1 other NPI on this enrollment
Practice locations: Rock Valley, IA; Inwood, IA; Rock Rapids, IA; Hull, IA; George, IA
O20061104000578 IA Part A Provider - Critical Access Hospital 5193718757 Receives reassigned benefits from 97 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rock Valley, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629023429. Details of each certification follow.

Hospital certification: CCN 161336

Legal name
HEGG MEMORIAL HOSPITAL
Doing business as
HEGG MEMORIAL HEALTH CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Mar 1, 2002
Last certification
Nov 6, 2020
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Mar 18, 1966 in IA
Enrollment address
1202 21St Ave
Rock Valley, IA 51247-1420

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Hegg Memorial Health CenterCCN 161336 · All quality measures
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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
William Slater Individual Corporate OfficerCfo Nov 9, 2018
Glenn Alan Zevenbergen Individual Contracted Managing EmployeeCeo Dec 20, 2003 100%
Corporate OfficerCeo Dec 20, 2003 100%
Jason Vansurksum Individual Corporate DirectorChairman Jan 1, 2020

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Hegg Home Health CareRock Valley, IA, CCN 167236 Home health agency Operational/Managerial Control (100%) Jun 15, 2009

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 99

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 99

Affiliated clinicians 55

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

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249862400000",
    "number": "1629023429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 HEGG DR",
            "city": "ROCK VALLEY",
            "state": "IA",
            "postal_code": "512471445",
            "telephone_number": "712-476-8100",
            "fax_number": "712-476-8190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 21ST AVENUE",
            "city": "ROCK VALLEY",
            "state": "IA",
            "postal_code": "512471445",
            "telephone_number": "712-476-8100",
            "fax_number": "712-476-8190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEGG MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2009-08-10",
        "status": "A",
        "authorized_official_last_name": "LOUDENBACK",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_middle_name": "LADD",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "712-476-8150",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IA",
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0201089",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0129528",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hegg Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rock Valley, IA

Sources for this page

Verify at the official NPI Registry.