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Palmer Lutheran Health Center, Inc

Organization Active NPI Rural Health Clinic/Center · West Union, IA

NPI 1639533763 · NPPES record last updated Nov 29, 2018

Key facts

NPI
1639533763
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
PALMER LUTHERAN HEALTH CENTER, INC
Practice address
110 Jefferson St
West Union, IA 52175-1022
Phone
(563) 422-3810
NPI assigned
Apr 5, 2016
Organization subpart
Yes
Parent organization (as reported)
GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.

Authorized official

Name
Patrice Kuennen
Title
Ceo
Phone
(563) 422-3811

Other NPIs with the same Medicare PAC ID 9

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

Corporate family (same tax ID) 11

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

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

Facilities with the same owner 49

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

View all 49

Practitioners 37

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

View all 37

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IA

Rural health clinic certification: CCN 168582

Legal name
PALMER LUTHERAN HEALTH CENTER INC
Doing business as
GUNDERSEN PALMER LUTHERAN HOSPITAL AND CLINICS - WEST UNION
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 20, 1995
Last certification
Aug 8, 2023
Ownership / control type
2B
Most recent change of ownership
Jul 1, 2016 (1 total)
Organization structure
Corporation · Non-profit
Enrollment address
110 Jefferson St
West Union, IA 52175-1022
Related CCNs
161316

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
Rachel Kathryn Albrecht
Individual 		Corporate Director
Board Member		 Jan 1, 2023
Kristi M Flack
Individual 		Corporate Director
Director		 Jan 24, 2018
Thomas Tornstrom
Individual 		Corporate Director Jan 1, 2023
Nicole Havenstrite
Individual 		Corporate Director
Board Member		 Jan 1, 2024
Patrice R Kuennen
Individual 		Corporate Officer Oct 8, 2018
W-2 Managing Employee Oct 8, 2018
Brenda S Moser
Individual 		Corporate Officer
Finance Administrator		 Jan 1, 2025
Bellin Gundersen Health System Inc
Organization · La Crosse, WI
Corporation, Non-profit 		5% Or Greater Indirect Ownership Interest Nov 30, 2022 100%
Operational/Managerial Control Nov 30, 2022 100%
Jodi Webb
Individual 		Corporate Director
Board Member		 Jan 1, 2025
Gundersen Lutheran Health System Inc
Organization · La Crosse, WI
Corporation, Non-profit 		5% Or Greater Direct Ownership Interest Jul 1, 2016 100%
Operational/Managerial Control Jul 1, 2016
Charles L Johnson
Individual 		Corporate Director Jan 21, 2020

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20160811000117 IA Part a Provider - Rural Health Clinic 4284544255 Practice locations: West Union, IA

National Provider Directory

Tax ID family
Palmer Lutheran HLTH Center (12 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

110 Jefferson St
West Union, IA 52175-1022

Mailing address

110 Jefferson St
West Union, IA 52175-1022
Phone (563) 422-3810

Other names

  • Gundersen Palmer Lutheran Hospital and Clinics - West Union Doing business as

Other providers in West Union, IA

All providers in West Union, IA · Rural Health Clinic/Center in Iowa

Sources for this page

Verify at the official NPI Registry.