Ottumwa Health Group LLC
Organization Active NPI Rural Health Clinic/Center · Ottumwa, IA
NPI 1649891722 · NPPES record last updated Sep 26, 2024
Key facts
- NPI
- 1649891722
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- OTTUMWA HEALTH GROUP LLC
- Practice address
- 1013 Pennsylvania Ave Ste E
Ottumwa, IA 52501-2110 - Phone
- (641) 684-3200
- Fax
- (641) 682-0204
- NPI assigned
- Apr 30, 2020
- Organization subpart
- No
Authorized official
- Name
- Charlotte Lawrence
- Title
- Secretary
- Phone
- (615) 920-7000
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 4
Facilities with the same owner 19
Practitioners 31
-
Dallas Black, ARNP
-
Shelley Bechtel, FNP-BC
-
Amanda J Davis, ARNP
-
Shawn Dawson, M.D.
-
Dominic A Formaro Jr., D.O.
-
Jessica Ann Hicks, D.O.
-
Billie June Lanham, FNP-C
-
Michael Bentley Scherb, M.D.
-
Abigail Rae Storto, MSN, CNM, WHNP-BC
-
Peggy Sue Swank, ARNP
-
Mark A Tannenbaum, M.D.
-
Lori Ann Wells, ARNP
-
Steven K. Branch, M.D., PH.D.
-
Carol L McIntyre, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 16D2116441 | Ottumwa Health Group, LLC | Certificate of waiver | Jul 25, 2026 |
| 16D2154559 | Ottumwa Health Group, LLC | Certificate of waiver | Sep 13, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA
Rural health clinic certification: CCN 168978
- Legal name
- OTTUMWA HEALTH GROUP LLC
- Doing business as
- EASYCARE WALK IN CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 29, 2020
- Last certification
- Oct 29, 2020
- Ownership / control type
- 1B
- Organization structure
- LLC · Proprietary
- Enrollment address
- 1013 Pennsylvania Ave
Ste E
Ottumwa, IA 52501-2110
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Pamela Kane |
Corporate Officer |
Aug 9, 2022 | |
| DSB Acquisition LLC |
5% Or Greater Indirect Ownership Interest | Nov 16, 2018 | 100% |
| Laura C Hinson |
Corporate Officer |
Mar 12, 2025 | |
| Ottumwa Physicians LLC |
5% Or Greater Direct Ownership Interest | Nov 16, 2018 | 100% |
| Lifepoint Health Inc |
5% Or Greater Indirect Ownership Interest | Nov 16, 2018 | 100% |
| Charlotte E Lawrence |
Corporate Officer |
Jan 21, 2022 | |
| Regionalcare Hospital Partners LLC |
5% Or Greater Indirect Ownership Interest | Nov 16, 2018 | 100% |
| RCHP-Ottumwa Holdings Inc |
5% Or Greater Indirect Ownership Interest | Nov 16, 2018 | 100% |
| Elliott Brown |
Corporate Officer |
Apr 2, 2026 | |
| RCHP LLC |
5% Or Greater Indirect Ownership Interest | Nov 16, 2018 | 100% |
| Klaus Michael Boel |
Corporate Officer |
Aug 19, 2024 | |
| W-2 Managing Employee | Aug 19, 2024 | ||
| Christopher J Monte |
Corporate Officer |
Nov 16, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100927001257 | IA | Part B Supplier - Clinic/Group Practice | 3971629924 |
Receives reassigned benefits from 86 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Sigourney, IA; Centerville, IA; Ottumwa, IA; Fairfield, IA; Eddyville, IA; Bloomfield, IA |
| O20200612000614 | IA | Part a Provider - Rural Health Clinic | 3971629924 | Practice locations: Ottumwa, IA |
National Provider Directory
- Tax ID family
- Ottumwa Health Group LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1013 Pennsylvania Ave Ste E
Ottumwa, IA 52501-2110
Mailing address
330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000
Other names
- EasyCare Walk In Clinic
Other providers in Ottumwa, IA
- Ottumwa Express Clinic
- Ottumwa Health Group LLC
- Ottumwa Health Group LLC
- Ottumwa Health Group LLC
- Ottumwa Health Group LLC
- Ottumwa Health Group LLC
- Ottumwa Mental Wellness Center
- Ottumwa Neurological Associates, PC
- Ottumwa Obstetrics and Gynecology, P.C.
- Ottumwa Psychiatric Clinic PC
All providers in Ottumwa, IA · Rural Health Clinic/Center in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.