Delaware County Memorial Hospital
Organization Active NPI Rural Health Clinic/Center · Dyersville, IA
NPI 1689264756 · NPPES record last updated Jan 29, 2021
Key facts
- NPI
- 1689264756
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- DELAWARE COUNTY MEMORIAL HOSPITAL
- Practice address
- 980 Field of Dreams Way
Dyersville, IA 52040-2521 - Phone
- (563) 875-2147
- Fax
- (563) 875-2029
- NPI assigned
- Jan 22, 2021
- Organization subpart
- No
Authorized official
- Name
- Danette Kramer
- Title
- Cfo
- Phone
- (563) 927-7537
Owned or controlled facilities with NPI records 8
Other NPIs with the same Medicare PAC ID 10
Corporate family (same tax ID) 11
Related certifications (CCN) 1
Practitioners 178
-
Seth Nicolas Additon, DNP, CRNA
-
Omar H Akhtar, MD
-
Bridget Milene Baker, DNP, ARNP, FNP-BC, P
-
Luke Brunkhorst, D.O.
-
Janice M Budzine, ARNP
-
Jill L Buschmann, ARNP
-
Isaac Albert Butler, CRNA
-
Jennifer Marie Chastek, CRNA
-
Scott J Chastek, CRNA / ARNP
-
Scot R Christiansen, M.D.
-
Sarah Cisco, CRNA
-
Clinton Thomas Cummings, D.O.
-
Blanka Divisova, M.D.
-
Jenny Lynn Duffie, ARNP, FNP-C
-
Derek Manson Dzaboff, ARNP FNP-BC
-
April Ehrler, ARNP
-
Blake Eyberg, MD
-
Stephanie Elaine Fangman, PA-C
-
Katherine Therese Gansen, ARNP, FNP-BC
-
Timothy P Gerst, M.D.
-
Elizabeth M Giedt, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Rural health clinic certification: CCN 168651
- Legal name
- DELAWARE COUNTY MEMORIAL HOSPITAL
- Doing business as
- REGIONAL FAMILY HEALTH DYERSVILLE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jan 15, 2021
- Last certification
- Jan 15, 2021
- Ownership / control type
- 2B
- Organization structure
- Government · Non-profit
- Enrollment address
- 980 Field of Dreams Way
Dyersville, IA 52040 - Related CCNs
- 161343
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Kathy Swift |
Corporate Director |
Jan 2, 2023 | 100% |
| John Zietlow |
Corporate Director |
Aug 19, 2024 | 100% |
| Jane Candace Sherman |
Corporate Director |
Jan 2, 2023 | 100% |
| Cathy Lilienthal |
Corporate Director |
Sep 18, 2017 | 100% |
| Steve H Palmer |
Corporate Director |
Jun 1, 2004 | 100% |
| Danette R Kramer |
Corporate Director |
Jan 18, 2021 | 100% |
| Operational/Managerial Control |
Jan 18, 2021 | 100% | |
| Joe D Keith |
Corporate Director |
Jan 2, 2001 | 100% |
| Chris Tegeler |
Corporate Director |
Jul 1, 2008 | 100% |
All facility ownership & control disclosures 7
| Facility | Type | Role | Since |
|---|---|---|---|
| Regional Medical Center |
Hospital | Operational/Managerial Control | Aug 28, 2013 |
| Regional Medical Center |
Hospital | Operational/Managerial Control | Aug 28, 2013 |
| Regional Family Health Edgewood |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Regional Family Health Hopkinton |
Rural health clinic | Operational/Managerial Control | Apr 1, 2009 |
| Regional Family Health Manchester |
Rural health clinic | Operational/Managerial Control (100%) | Apr 1, 2009 |
| Regional Family Health Strawberry Point |
Rural health clinic | Operational/Managerial Control | Apr 1, 2009 |
| Regional Family Health Winthrop |
Rural health clinic | Operational/Managerial Control (100%) | Aug 1, 1966 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210204001518 | IA | Part a Provider - Rural Health Clinic | 2062316375 | Practice locations: Dyersville, IA |
National Provider Directory
- Tax ID family
- Delaware County Hosp
Locations
980 Field of Dreams Way
Dyersville, IA 52040
Phone (563) 875-2147
709 W Main St
#359
Manchester, IA 52057
Phone (563) 927-7457
712 W Main St
#359
Manchester, IA 52057
Phone (563) 927-7303
817 W Fayette St
Manchester, IA 52057
Phone (563) 927-7777
116 E Charles St
Oelwein, IA 50662
Phone (319) 283-7432
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
980 Field of Dreams Way
Dyersville, IA 52040-2521
Mailing address
PO Box 359
Manchester, IA 52057-0359
Phone (563) 927-7457
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831178060 | Medicaid | IA |
Other names
- REGIONAL FAMILY HEALTH DYERSVILLE
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | MANCHESTER |
Other providers in Dyersville, IA
- Karlyn Bouska
- Rebekah Yvonne Bradtke
- Kurt V Burbach
- Sara Linn Buysman
- City Chiropractic Inc
- Dubuque Podiatry, PC
- Morgan Dunahoo
- Elite Dental, P.C.
- Daniel George Engelbrecht
- Eyesite
All providers in Dyersville, 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 Jan 29, 2021. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.