NPIMap

Organization Active NPI

Palo Alto County Hospital

  • Rural Health Clinic/Center
  • Emmetsburg, IA
National Provider Identifier
1639243116
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PALO ALTO COUNTY HOSPITAL
Practice address
3201 1St St
Emmetsburg, IA 50536-2516
Phone
(712) 852-5555
Fax
(712) 852-5560
NPI assigned
Nov 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

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

Authorized official

Name
Desiree A Einsweiler
Title
Ceo
Phone
(712) 852-5401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

3201 1St St
Emmetsburg, IA 50536-2516

Mailing address

3201 1St St
Emmetsburg, IA 50536-2516
Phone (712) 852-5500

Other identifiers 2

IdentifierTypeStateIssuer
63482OtherIAWELLMARK
0634857MedicaidIA

Other names 1

  • FAMILY PRATICE CLINIC -EMMETSBURG Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address HIM@pamhn.cernerdirect.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090605000576 IA Part A Provider - Rural Health Clinic 4486563061 Practice locations: Emmetsburg, IA

Rural health clinic certification: CCN 163482

Legal name
PALO ALTO COUNTY HOSPITAL
Doing business as
FAMILY PRACTICE CLINIC EMMETSBURG
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 1, 2001
Last certification
Sep 1, 2021
Ownership / control type
2B
Organization structure
GovernmentNon-profit
Enrollment address
3201 1St St
Emmetsburg, IA 50536-2516
Related CCNs
161357

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

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Palo Alto Comm Hospital9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

107 W Division St
#48
West Bend, IA 50597

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
Coleen R Ruddy Individual W-2 Managing Employee Feb 21, 2005
Cynthia Magee Individual Corporate Director Jan 23, 2019
Terry Naig Individual Corporate Director Aug 22, 2012
Dawn Schmidt Individual Corporate Director Aug 27, 2008
Collette Johnson Individual Corporate Director Jun 20, 2016
W-2 Managing Employee Jun 20, 2016
Operational/Managerial Control Jun 20, 2017
Melanie Flynn Individual Corporate Director Jan 27, 2021
Richard Brennan Individual Corporate Director Feb 20, 2019
Jana Harris Individual Corporate Director Jan 23, 2019
Jonathan Dean Moe Individual Contracted Managing Employee Feb 1, 2021
Corporate Officer Feb 1, 2021
Operational/Managerial Control Feb 1, 2021
Burt J. Hobart Individual Corporate Director Nov 1, 1992

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Palo Alto County HospitalEmmetsburg, IA, CCN 161357 Hospital Operational/Managerial Control Jan 2, 2013
Palo Alto County HospitalEmmetsburg, IA, CCN 16Z357 Hospital Operational/Managerial Control Jan 2, 2008
Palo Alto Community Health ServicesEmmetsburg, IA, CCN 167049 Home health agency Operational/Managerial Control Jan 10, 2012
Hospice of Palo Alto CountyEmmetsburg, IA, CCN 161530 Hospice Operational/Managerial Control Sep 9, 1993
Family Practice Clinic West BendWest Bend, IA, CCN 163417 Rural health clinic Operational/Managerial Control Sep 12, 1994

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1639243116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201 1ST ST",
            "city": "EMMETSBURG",
            "state": "IA",
            "postal_code": "505362516",
            "telephone_number": "712-852-5500",
            "fax_number": "712-852-5409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 1ST ST",
            "city": "EMMETSBURG",
            "state": "IA",
            "postal_code": "505362516",
            "telephone_number": "712-852-5555",
            "fax_number": "712-852-5560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALO ALTO COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A",
        "authorized_official_last_name": "EINSWEILER",
        "authorized_official_first_name": "DESIREE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-852-5401"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "63482",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0634857",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "HIM@pamhn.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "PACHS Direct Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "3201 1st St",
            "city": "Emmetsburg",
            "state": "IA",
            "country_code": "US",
            "postal_code": "505362516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "FAMILY PRATICE CLINIC -EMMETSBURG",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FAMILY PRATICE CLINIC -EMMETSBURG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Emmetsburg, IA

Sources for this page

Verify at the official NPI Registry.