NPIMap

Organization Active NPI

Delaware County Memorial Hospital

Doing business as Regional Family Health Dyersville

  • Rural Health Clinic/Center
  • Dyersville, IA
National Provider Identifier
1689264756
Registry record updated Jan 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DELAWARE COUNTY MEMORIAL HOSPITAL
Doing business as
Regional Family Health Dyersville
Practice address
980 Field of Dreams Way
Dyersville, IA 52040-2521
Phone
(563) 875-2147
Fax
(563) 875-2029
NPI assigned
Jan 22, 2021
Last updated
Jan 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2021

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

Authorized official

Name
Danette Kramer
Title
Cfo
Phone
(563) 927-7537

Specialties & licenses 1

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

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 1

IdentifierTypeStateIssuer
1831178060MedicaidIA

Other names 1

  • REGIONAL FAMILY HEALTH DYERSVILLE Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL MANCHESTER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210204001518 IA Part A Provider - Rural Health Clinic 2062316375 Practice locations: Dyersville, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689264756. Details of each certification follow.

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
GovernmentNon-profit
Enrollment address
980 Field of Dreams Way
Dyersville, IA 52040
Related CCNs
161343

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

Other NPIs with the same Medicare PAC ID 10

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

National Provider Directory

National Provider Directory
Tax ID family
DCMH Anesthesia12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

980 Field of Dreams Way
Dyersville, IA 52040
Phone (563) 875-2147

2300 Swan Lake Blvd
Independence, IA 50644
Phone (319) 334-5155

712 W Main St
#359
Manchester, IA 52057
Phone (563) 927-7303

116 E Charles St
Oelwein, IA 50662
Phone (319) 283-7432

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Kathy Swift Individual Corporate DirectorBoard Member Jan 2, 2023 100%
John Zietlow Individual Corporate DirectorBoard Member Aug 19, 2024 100%
Jane Candace Sherman Individual Corporate DirectorBoard Member Jan 2, 2023 100%
Cathy Lilienthal Individual Corporate DirectorBoard Member Sep 18, 2017 100%
Steve H Palmer Individual Corporate DirectorBoard Member Jun 1, 2004 100%
Danette R Kramer Individual Corporate DirectorCfo Jan 18, 2021 100%
Operational/Managerial ControlCfo Jan 18, 2021 100%
Joe D Keith Individual Corporate DirectorBoard Member Jan 2, 2001 100%
Chris Tegeler Individual Corporate DirectorBoard Member Jul 1, 2008 100%

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Regional Medical CenterManchester, IA, CCN 161343 Hospital Operational/Managerial Control Aug 28, 2013
Regional Medical CenterManchester, IA, CCN 16Z343 Hospital Operational/Managerial Control Aug 28, 2013
Regional Family Health EdgewoodEdgewood, IA, CCN 168531 Rural health clinic Operational/Managerial Control Jan 1, 1966
Regional Family Health HopkintonHopkinton, IA, CCN 168529 Rural health clinic Operational/Managerial Control Apr 1, 2009
Regional Family Health ManchesterManchester, IA, CCN 168530 Rural health clinic Operational/Managerial Control (100%) Apr 1, 2009
Regional Family Health Strawberry PointStrawberry Point, IA, CCN 168528 Rural health clinic Operational/Managerial Control Apr 1, 2009
Regional Family Health WinthropWinthrop, IA, CCN 168554 Rural health clinic Operational/Managerial Control (100%) Aug 1, 1966

Owned or controlled facilities with NPI records 8

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

Practitioners & affiliated clinicians

Practitioners 166

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 166

NPI Registry JSON

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

{
    "created_epoch": "1611273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611878400000",
    "number": "1689264756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 359",
            "city": "MANCHESTER",
            "state": "IA",
            "postal_code": "520570359",
            "telephone_number": "563-927-7457",
            "fax_number": "563-927-7518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 FIELD OF DREAMS WAY",
            "city": "DYERSVILLE",
            "state": "IA",
            "postal_code": "520402521",
            "telephone_number": "563-875-2147",
            "fax_number": "563-875-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELAWARE COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-22",
        "last_updated": "2021-01-29",
        "certification_date": "2021-01-29",
        "status": "A",
        "authorized_official_last_name": "KRAMER",
        "authorized_official_first_name": "DANETTE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "563-927-7537"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831178060",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "MANCHESTER",
            "affiliation": "N",
            "address_1": "980 Field Of Dreams Way",
            "city": "Dyersville",
            "state": "IA",
            "country_code": "US",
            "postal_code": "520402521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "REGIONAL FAMILY HEALTH DYERSVILLE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dyersville, IA

Sources for this page

Verify at the official NPI Registry.