NPIMap

Organization Active NPI

Cass County Memorial Hospital

Doing business as Anita Medical Center Rural Health Clinic

  • Rural Health Clinic/Center
  • Atlantic, IA
National Provider Identifier
1649471699
Registry record updated Jan 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CASS COUNTY MEMORIAL HOSPITAL
Doing business as
Anita Medical Center Rural Health Clinic
Practice address
1501 E 10TH St
Atlantic, IA 50022-1936
Phone
(712) 243-2850
Fax
(712) 243-7423
NPI assigned
May 29, 2007
Last updated
Jan 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2023

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

Authorized official

Name
Abbey Stangl
Title
Cfo
Phone
(712) 243-7804

Specialties & licenses 1

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

Addresses

Primary practice location

1501 E 10TH St
Atlantic, IA 50022-1936

Mailing address

720 Main Street
Anita, IA 50020-0276
Phone (712) 762-4462

Other identifiers 1

IdentifierTypeStateIssuer
1649471699MedicaidIA

Other names 1

  • Anita Medical Center Rural 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
O20031231000681 IA Part B Supplier - Clinic/Group Practice 5294634994 Receives reassigned benefits from 126 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anita, IA; Atlantic, IA; Clarinda, IA; Griswold, IA; Massena, IA; Red Oak, IA
O20070614000342 IA Part A Provider - Rural Health Clinic 5294634994 Practice locations: Anita, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649471699. Details of each certification follow.

Rural health clinic certification: CCN 168526

Legal name
CASS COUNTY MEMORIAL HOSPITAL
Doing business as
ANITA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 2007
Last certification
Sep 21, 2021
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
720 Main St
Anita, IA 50020-1060
Related CCNs
161376

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 4

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
16D0382550Anita Medical Center720 Main Street, Anita, IA 50020Certificate of waiverNov 2, 2026

National Provider Directory

National Provider Directory
Tax ID family
Cass County Hospital7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Brett a Altman Individual Corporate OfficerCeo Jan 3, 2017
W-2 Managing EmployeeCeo Jan 3, 2017
Operational/Managerial ControlCeo Jan 3, 2017
Nathan Brown Individual Corporate Director Mar 24, 2009
Linda Pelzer Individual Corporate Director Nov 20, 2019
Julia Ann Pollock Individual Corporate Director Jan 1, 2013
Cass County Memorial Hospital Organization, Atlantic, IA Operational/Managerial Control May 25, 2007
Kolton E Hewlett Individual Corporate OfficerCfo Dec 30, 2023
W-2 Managing EmployeeCfo Dec 30, 2023
Elaine K Berry Individual W-2 Managing EmployeeMD; Aug 1, 2021
Joanne Lorence Individual Corporate Director Jul 20, 2016
Leanne Pellett Individual Corporate Director Jan 1, 2009
Roger Lynn Herring Individual Corporate Director Jan 1, 2013
Michael John Klocke Individual Corporate Director Jan 1, 2017

Owners & managing parties with NPI records 9

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Griswold Medical CenterGriswold, IA, CCN 168525 Rural health clinic Operational/Managerial Control May 25, 2007
Massena Medical CenterMassena, IA, CCN 168524 Rural health clinic Operational/Managerial Control May 25, 2007

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

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

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": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673827200000",
    "number": "1649471699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 MAIN STREET",
            "city": "ANITA",
            "state": "IA",
            "postal_code": "500200276",
            "telephone_number": "712-762-4462",
            "fax_number": "712-243-7423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 E 10TH ST",
            "city": "ATLANTIC",
            "state": "IA",
            "postal_code": "500221936",
            "telephone_number": "712-243-2850",
            "fax_number": "712-243-7423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASS COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2023-01-16",
        "certification_date": "2023-01-16",
        "status": "A",
        "authorized_official_last_name": "STANGL",
        "authorized_official_first_name": "ABBEY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "712-243-7804"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649471699",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anita Medical Center Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Anita Medical Center Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlantic, IA

Sources for this page

Verify at the official NPI Registry.