NPIMap

Organization Active NPI

Ida County Iowa Community Hospital

Doing business as Horn Physicians Clinic Holstein

  • Rural Health Clinic/Center
  • Holstein, IA
National Provider Identifier
1689249922
Registry record updated May 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
IDA COUNTY IOWA COMMUNITY HOSPITAL
Doing business as
Horn Physicians Clinic Holstein
Practice address
1400 S Kiel St
Holstein, IA 51025-5091
Phone
(712) 368-6300
Fax
(712) 368-6304
NPI assigned
May 20, 2021
Last updated
May 21, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
IDA COUNTY IOWA COMMUNITY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 21, 2021

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

Authorized official

Name
Glen J Winekauf
Title
Ceo
Phone
(712) 364-3311

Specialties & licenses 1

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

Addresses

Primary practice location

1400 S Kiel St
Holstein, IA 51025-5091

Mailing address

701 E 2ND St
Ida Grove, IA 51445-1699
Phone (712) 364-3311

Other names 1

  • Horn Physicians Clinic Holstein Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220407001571 IA Part A Provider - Rural Health Clinic 9537070826 Practice locations: Holstein, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689249922. Details of each certification follow.

Rural health clinic certification: CCN 168665

Legal name
IDA COUNTY IOWA COMMUNITY HOSPITAL
Doing business as
HORN PHYSICIANS CLINIC HOLSTEIN
Organization structure
CorporationNon-profit
Incorporated
Nov 25, 1960 in IA
Enrollment address
1400 S Kiel St
Holstein, IA 51025-5091

Other NPIs with the same Medicare PAC ID 6

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

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
16D2221124Horn Physicians Clinic-Holstein1400 S Kiel, Holstein, IA 51025ComplianceNov 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
Horn Memorial Hospital9 organizations share this tax ID, including this one
Part of
Horn Memorial Hospital

Other organizations with this tax ID 8

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

Locations

700 E 2nd St
Ste 2
Ida Grove, IA 51445
Phone (712) 364-2514

520 Main St
Mapleton, IA 51034
Phone (712) 881-4676

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Shannon M Fox Individual Corporate OfficerCfo May 1, 2024
W-2 Managing EmployeeCfo May 1, 2024
Operational/Managerial ControlCfo May 1, 2024
Denise D Redenius Individual Corporate Director Apr 24, 2023
Michelle K Weber Individual W-2 Managing EmployeeChief Primary Clinics Officer Oct 1, 2009
Operational/Managerial ControlChief Primary Clinics Officer Oct 1, 2009
Kristeen R Gunderson Individual Corporate Director May 23, 2022
Cole Boger Individual Corporate Officer May 23, 2022
Corporate Director Jun 22, 2020
Sharon K Vande Vegte Individual W-2 Managing EmployeeMD; Feb 3, 2023
Operational/Managerial ControlMedical Director Feb 3, 2023
David Forbes Individual Corporate Director Apr 23, 2018
Robert D Paulsen Individual Corporate Director Apr 25, 2022
Emily Lange Individual Corporate OfficerCco/Cno Dec 6, 2020
W-2 Managing EmployeeCco/Cno Dec 6, 2020
Operational/Managerial ControlCco/Cno Dec 6, 2020
Vance Lundell Individual Corporate Officer May 1, 2024
Corporate Director Apr 23, 2018
Kelli Boyle Individual Corporate Officer May 23, 2022
Corporate Director Apr 23, 2018
Glen Winekauf Individual Corporate OfficerCeo Sep 14, 2017
W-2 Managing EmployeeCeo Sep 14, 2017
Operational/Managerial ControlCeo Sep 14, 2017
Jean Burns Individual Corporate Officer Apr 23, 2018
Corporate Director Apr 25, 2016
Christina Kjar Hanson Individual Corporate Director Apr 22, 2019

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 41

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 41

NPI Registry JSON

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

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621555200000",
    "number": "1689249922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 E 2ND ST",
            "city": "IDA GROVE",
            "state": "IA",
            "postal_code": "514451699",
            "telephone_number": "712-364-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S KIEL ST",
            "city": "HOLSTEIN",
            "state": "IA",
            "postal_code": "510255091",
            "telephone_number": "712-368-6300",
            "fax_number": "712-368-6304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDA COUNTY IOWA COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IDA COUNTY IOWA COMMUNITY HOSPITAL",
        "enumeration_date": "2021-05-20",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A",
        "authorized_official_last_name": "WINEKAUF",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-364-3311"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Horn Physicians Clinic Holstein",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Horn Physicians Clinic Holstein",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holstein, IA

Sources for this page

Verify at the official NPI Registry.