NPIMap

Organization Active NPI

Greater Regional Medical Center

Doing business as Mount Ayr Community Health Clinic

  • Rural Health Clinic/Center
  • Mount Ayr, IA
National Provider Identifier
1639684335
Registry record updated Jan 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GREATER REGIONAL MEDICAL CENTER
Doing business as
Mount Ayr Community Health Clinic
Practice address
120 S Taylor St
Mount Ayr, IA 50854-1829
Phone
(641) 464-8971
NPI assigned
Dec 5, 2017
Last updated
Jan 31, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2019

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

Authorized official

Name
Matthew L McCutchan
Title
Cfo
Phone
(641) 782-3899

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

120 S Taylor St
Mount Ayr, IA 50854-1829

Mailing address

1700 W Townline St
Creston, IA 50801-1054
Phone (641) 782-7091

Other names 1

  • MOUNT AYR COMMUNITY HEALTH CLINIC Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040205000926 IA Part B Supplier - Clinic/Group Practice 9234041013 Receives reassigned benefits from 82 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Creston, IA; Osceola, IA; Greenfield, IA
O20190311001046 IA Part A Provider - Rural Health Clinic 9234041013 Practice locations: Mount Ayr, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639684335. Details of each certification follow.

Rural health clinic certification: CCN 168638

Legal name
GREATER REGIONAL MEDICAL CENTER
Doing business as
MOUNT AYR COMMUNITY HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 16, 2020
Last certification
Apr 16, 2020
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
120 S Taylor St
Mount Ayr, IA 50854-1829
Related CCNs
161365

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 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2142996Mount Ayr Community Health Clinic120 S Taylor Street, Mount Ayr, IA 50854Certificate of waiverJan 22, 2028

National Provider Directory

National Provider Directory

Locations

1610 W Townline St
Creston, IA 50801
Phone (641) 782-2131

120 S Taylor St
Mount Ayr, IA 50854
Phone (641) 464-8971

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
Sharon Kay McKie Individual Corporate Officer Jan 1, 2011
Corporate Director Jan 1, 1997
Lucas E Neitzel Individual W-2 Managing EmployeeAdministrator; Clinic Director Mar 6, 2017
Operational/Managerial ControlClinic Director Mar 6, 2017
Central Iowa Hospital Corporation Organization, Des Moines, IA Corporation, Non-profit Operational/Managerial Control Jul 1, 2017
Gina M Perri Individual W-2 Managing EmployeeMedical Director Oct 1, 2022
Operational/Managerial ControlMedical Director Oct 1, 2022
Kenneth Dawson Stults Individual Corporate Officer Jan 27, 2025
Corporate Director Jan 26, 2015
Thomas L Lesan Individual Corporate Officer Jan 23, 2023
Corporate Director Mar 11, 2010
Matthew L McCutchan Individual Corporate OfficerCfo Nov 25, 2013
W-2 Managing EmployeeCfo Mar 29, 2009
Operational/Managerial ControlCfo Mar 29, 2009
Julie a Lanning Individual Corporate Director Aug 26, 2019
R Jack Davis Individual Corporate Officer Jan 23, 2012
Corporate Director Jan 1, 1995
Monte E. Neitzel Individual Corporate OfficerCeo Nov 25, 2013
W-2 Managing EmployeeCeo Aug 4, 2003
Operational/Managerial ControlCeo Aug 4, 2003

Owners & managing parties with NPI records 8

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 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1512432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548892800000",
    "number": "1639684335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 W TOWNLINE ST",
            "city": "CRESTON",
            "state": "IA",
            "postal_code": "508011054",
            "telephone_number": "641-782-7091",
            "fax_number": "641-782-3830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 S TAYLOR ST",
            "city": "MOUNT AYR",
            "state": "IA",
            "postal_code": "508541829",
            "telephone_number": "641-464-8971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-05",
        "last_updated": "2019-01-31",
        "status": "A",
        "authorized_official_last_name": "MCCUTCHAN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "641-782-3899"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOUNT AYR COMMUNITY HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Ayr, IA

Sources for this page

Verify at the official NPI Registry.