NPIMap

Organization Active NPI

Palmer Lutheran Health Center, Inc

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

  • Rural Health Clinic/Center
  • West Union, IA
National Provider Identifier
1639533763
Registry record updated Nov 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PALMER LUTHERAN HEALTH CENTER, INC
Doing business as
Gundersen Palmer Lutheran Hospital and Clinics - West Union
Practice address
110 Jefferson St
West Union, IA 52175-1022
Phone
(563) 422-3810
NPI assigned
Apr 5, 2016
Last updated
Nov 29, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 29, 2018

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

Authorized official

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

Specialties & licenses 2

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

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 1

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

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639533763. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
110 Jefferson St
West Union, IA 52175-1022
Related CCNs
161316

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

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Palmer Lutheran Health Center Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

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
Rachel Kathryn Albrecht Individual Corporate DirectorBoard Member Jan 1, 2023
Kristi M Flack Individual Corporate DirectorDirector Jan 24, 2018
Thomas Tornstrom Individual Corporate Director Jan 1, 2023
Nicole Havenstrite Individual Corporate DirectorBoard 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 OfficerFinance 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 DirectorBoard 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

Facilities with the same owner 49

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

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1459814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543449600000",
    "number": "1639533763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 JEFFERSON ST",
            "city": "WEST UNION",
            "state": "IA",
            "postal_code": "521751022",
            "telephone_number": "563-422-3810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 JEFFERSON ST",
            "city": "WEST UNION",
            "state": "IA",
            "postal_code": "521751022",
            "telephone_number": "563-422-3810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMER LUTHERAN HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.",
        "enumeration_date": "2016-04-05",
        "last_updated": "2018-11-29",
        "status": "A",
        "authorized_official_last_name": "KUENNEN",
        "authorized_official_first_name": "PATRICE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "563-422-3811"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gundersen Palmer Lutheran Hospital and Clinics - West Union",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gundersen Palmer Lutheran Hospital and Clinics - West Union",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Union, IA

Sources for this page

Verify at the official NPI Registry.