NPIMap

Organization Active NPI

Mahaska County Hospital

Doing business as Mahaska Health

  • Emergency Medical Services (Emergency Medicine) Physician
  • Oskaloosa, IA
National Provider Identifier
1639159304
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
620092H Issued in IA
Legal business name
MAHASKA COUNTY HOSPITAL
Doing business as
Mahaska Health
Practice address
1229 C Ave E
Oskaloosa, IA 52577-4298
Phone
(641) 672-3100
Fax
(641) 672-3336
NPI assigned
Jan 19, 2006
Last updated
Oct 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Authorized official

Name
Kevin Deronde
Title
Ceo
Phone
(641) 672-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 620092H IA Primary

Addresses

Primary practice location

1229 C Ave E
Oskaloosa, IA 52577-4298

Mailing address

1229 C Ave E
Oskaloosa, IA 52577-4298
Phone (641) 672-3100

Other identifiers 2

IdentifierTypeStateIssuer
0172825MedicaidIA
17282OtherIAIA BLUE SHIELD PROVIDER N

Other names 1

  • MAHASKA HEALTH Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041202000965 IA Part B Supplier - Clinic/Group Practice 2769388677 Receives reassigned benefits from 118 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New Sharon, IA; Pella, IA; Oskaloosa, IA; North Liberty, IA; Mason City, IA; Iowa City, IA; Coralville, IA

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
New Sharon Medical Center14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730073600000",
    "number": "1639159304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1229 C AVE E",
            "city": "OSKALOOSA",
            "state": "IA",
            "postal_code": "525774298",
            "telephone_number": "641-672-3100",
            "fax_number": "641-672-3336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1229 C AVE E",
            "city": "OSKALOOSA",
            "state": "IA",
            "postal_code": "525774298",
            "telephone_number": "641-672-3100",
            "fax_number": "641-672-3336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAHASKA COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A",
        "authorized_official_last_name": "DERONDE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "641-672-3100"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "IA",
            "license": "620092H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0172825",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IA BLUE SHIELD PROVIDER N",
            "identifier": "17282",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAHASKA HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oskaloosa, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; 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.