NPIMap

Organization Active NPI

Greene County Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Jefferson, IA
National Provider Identifier
1629153176
Registry record updated Jan 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
370024H Issued in IA
Legal business name
GREENE COUNTY MEDICAL CENTER
Practice address
1000 W Lincoln Way
Jefferson, IA 50129-1645
Phone
(515) 386-2114
Fax
(515) 386-3695
NPI assigned
Oct 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2022

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

Authorized official

Name
Chad Herman Butterfield
Title
Ceo
Phone
(515) 386-2114

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 370024H IA Primary

Addresses

Primary practice location

1000 W Lincoln Way
Jefferson, IA 50129-1645

Mailing address

1000 W Lincoln Way
Jefferson, IA 50129-1645
Phone (515) 386-2114

Other identifiers 1

IdentifierTypeStateIssuer
0655563MedicaidIA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040712000717 IA Part B Supplier - Clinic/Group Practice 0143208595 Receives reassigned benefits from 30 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jefferson, IA
O20120319000699 IA Part A Provider - Critical Access Hospital 0143208595 Practice locations: Jefferson, IA

Hospital certification: CCN 16Z325

Legal name
GREENE COUNTY MEDICAL CENTER
Doing business as
GREENE COUNTY MEDICAL CENTER
Organization structure
OtherNon-profit
Enrollment address
1000 W Lincoln Way
Jefferson, IA 50129-1645
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Tax ID family
Greene Co Med7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Douglas E Hawn Individual Corporate Officer Jan 23, 2020
Corporate Director Jan 1, 2009
Central Iowa Hospital Corporation Organization, Des Moines, IA Corporation, Non-profit Operational/Managerial Control Jul 1, 2011
Angela S Jewett Individual Corporate Director Nov 23, 2021
Mark T Wall Individual Contracted Managing EmployeeCfo Feb 28, 2022
Corporate OfficerCfo Feb 28, 2022
Operational/Managerial ControlCfo Feb 28, 2022
Rochelle L Guess Individual W-2 Managing EmployeePresident of Medical Staff Dec 28, 2021
Operational/Managerial ControlPresident of Medical Staff Dec 28, 2021
Doug Carman Individual Corporate Director Mar 24, 2022
Kim J Bates Individual Corporate Director Jan 22, 2010
William D Raney Individual Corporate Officer Dec 21, 2021
Corporate Director Mar 21, 2013
Katherine B Neese Individual Corporate Director Jan 23, 2020
James T Schleisman Individual Corporate Officer Jan 1, 1997
Corporate Director Jul 24, 1995
Chad H Butterfield Individual Contracted Managing EmployeeCeo Jul 27, 2020
Corporate OfficerCeo Jul 27, 2020
Operational/Managerial ControlCeo Jul 27, 2020

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 22

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

View all 22

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

Affiliated clinicians 4

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

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641945600000",
    "number": "1629153176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 W LINCOLN WAY",
            "city": "JEFFERSON",
            "state": "IA",
            "postal_code": "501291645",
            "telephone_number": "515-386-2114",
            "fax_number": "515-386-3695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W LINCOLN WAY",
            "city": "JEFFERSON",
            "state": "IA",
            "postal_code": "501291645",
            "telephone_number": "515-386-2114",
            "fax_number": "515-386-3695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENE COUNTY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "BUTTERFIELD",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "HERMAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "515-386-2114"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "IA",
            "license": "370024H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0655563",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson, IA

Sources for this page

Verify at the official NPI Registry.