NPIMap

Organization Active NPI

Delaware County Memorial Hospital

Doing business as Regional Family Health-Manchester

  • Rural Health Clinic/Center
  • Manchester, IA
National Provider Identifier
1699707257
Registry record updated Aug 15, 2011
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-Manchester
Practice address
709 W Main St
Manchester, IA 52057-1526
Phone
(563) 927-2629
Fax
(563) 927-5247
NPI assigned
Jul 6, 2006
Last updated
Aug 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2011

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

Authorized official

Name
Lon Butikofer
Title
Ceo
Phone
(563) 927-7308

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

709 W Main St
Manchester, IA 52057-1526

Mailing address

709 W Main St
PO Box 359
Manchester, IA 52057-1526
Phone (563) 927-2629

Other identifiers 2

IdentifierTypeStateIssuer
0638858MedicaidIA
0257899MedicaidIA

Other names 1

  • Regional Family Health-Manchester Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090601000259 IA Part A Provider - Rural Health Clinic 2062316375 Practice locations: Manchester, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699707257. Details of each certification follow.

Rural health clinic certification: CCN 168530

Legal name
DELAWARE COUNTY MEMORIAL HOSPITAL
Doing business as
REGIONAL FAMILY HEALTH MANCHESTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 1, 2009
Last certification
Mar 24, 2021
Ownership / control type
2B
Organization structure
GovernmentNon-profit
Enrollment address
709 W Main St
Manchester, IA 52057-0359
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
Pollpeter Jos12 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.

Ownership & related parties

All disclosed owners & managing parties 9

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
John Zietlow Individual Corporate DirectorBoard Member Aug 19, 2024 100%
Delaware County Memorial Hospital Organization, Manchester, IA Operational/Managerial Control Apr 1, 2009 100%
Jane Candace Sherman Individual Corporate DirectorBoard Member Jan 2, 2023
Cathy Lilienthal Individual Corporate Officer Sep 18, 2017
Steve H Palmer Individual Corporate Officer Jun 1, 2004
Danette R Kramer Individual Corporate OfficerCeo Jan 1, 2000 100%
Corporate DirectorCeo Feb 24, 2017 100%
W-2 Managing EmployeeCfo Apr 1, 2009
Joe D Keith Individual Corporate Officer Dec 2, 2001 100%
Chris Tegeler Individual Corporate Officer Jul 1, 2008

Owners & managing parties with NPI records 10

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

All facility ownership & control disclosures 6

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 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 7

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

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Practitioners 6

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": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313366400000",
    "number": "1699707257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 W MAIN ST",
            "address_2": "PO BOX 359",
            "city": "MANCHESTER",
            "state": "IA",
            "postal_code": "520571526",
            "telephone_number": "563-927-2629",
            "fax_number": "563-927-5247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 W MAIN ST",
            "city": "MANCHESTER",
            "state": "IA",
            "postal_code": "520571526",
            "telephone_number": "563-927-2629",
            "fax_number": "563-927-5247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELAWARE COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2011-08-15",
        "status": "A",
        "authorized_official_last_name": "BUTIKOFER",
        "authorized_official_first_name": "LON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "563-927-7308"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0638858",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0257899",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Regional Family Health-Manchester",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manchester, IA

Sources for this page

Verify at the official NPI Registry.