NPIMap

Organization Active NPI

Alegent Health Mercy Hospital Corning, Iowa

Doing business as CHI Health Mercy Corning

  • Emergency Medicine Physician
  • Corning, IA
National Provider Identifier
1649334574
Registry record updated Jan 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
ALEGENT HEALTH MERCY HOSPITAL CORNING, IOWA
Doing business as
CHI Health Mercy Corning
Practice address
603 Rosary Dr
Corning, IA 50841-1683
Phone
(641) 322-5245
NPI assigned
Dec 22, 2006
Last updated
Jan 27, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CHI NEBRASKAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 27, 2020

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

Authorized official

Name
Keith Jankuski
Title
Coo
Phone
(402) 343-4409

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU
Hematology & Oncology Physician 207RH0003X NU
Pediatrics Physician 208000000X NU
Physical Medicine & Rehabilitation Physician 208100000X NU

Addresses

Primary practice location

603 Rosary Dr
Corning, IA 50841-1683

Mailing address

603 Rosary Dr
Corning, IA 50841-1683
Phone (641) 322-5245

Other identifiers 3

IdentifierTypeStateIssuer
41469OtherIAMEDICARE PTAN
41473OtherIAMEDICARE PTAN
21536OtherIAMEDICARE PTAN

Other names 1

  • CHI Health Mercy Corning Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040209000263 IA Part B Supplier - Clinic/Group Practice 0547154940 Receives reassigned benefits from 53 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bedford, IA; Corning, IA; Lenox, IA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

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": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580083200000",
    "number": "1649334574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 ROSARY DR",
            "city": "CORNING",
            "state": "IA",
            "postal_code": "508411683",
            "telephone_number": "641-322-5245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 ROSARY DR",
            "city": "CORNING",
            "state": "IA",
            "postal_code": "508411683",
            "telephone_number": "641-322-5245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEGENT HEALTH MERCY HOSPITAL CORNING, IOWA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHI NEBRASKA",
        "enumeration_date": "2006-12-22",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A",
        "authorized_official_last_name": "JANKUSKI",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "402-343-4409"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "41469",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "41473",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "21536",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI Health Mercy Corning",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHI Health Mercy Corning",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Corning, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2020; 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.