NPIMap

Organization Active NPI

Guthrie County Hospital

Doing business as GCH Clinics

  • Family Medicine Physician
  • Adair, IA
National Provider Identifier
1710130588
Registry record updated Oct 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
28764 Issued in IA
Legal business name
GUTHRIE COUNTY HOSPITAL
Doing business as
GCH Clinics
Practice address
401 Audubon St
Adair, IA 50002-7708
Phone
(641) 742-1000
Fax
(641) 742-3414
NPI assigned
Oct 24, 2008
Last updated
Oct 25, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
GUTHRIE COUNTY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 25, 2023

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

Authorized official

Name
Mr. Christopher R Stipe
Title
Ceo
Phone
(641) 332-2201

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 28764 IA Primary
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

401 Audubon St
Adair, IA 50002-7708

Mailing address

710 N 12TH St
Guthrie Center, IA 50115-1549
Phone (641) 332-2201

Other identifiers 1

IdentifierTypeStateIssuer
1740265222MedicaidIA

Other names 1

  • GCH CLINICS Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lavonneh@gcho.securechart.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190820003587 IA Part A Provider - Rural Health Clinic 6204745110 Practice locations: Adair, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710130588. Details of each certification follow.

Rural health clinic certification: CCN 168620

Legal name
GUTHRIE COUNTY HOSPITAL
Doing business as
GCH CLINICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 24, 2019
Last certification
Sep 24, 2019
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
401 Audubon St
Adair, IA 50002-7708
Related CCNs
161314

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

Other NPIs with the same Medicare PAC ID 4

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
16D0980487GCH Clinics401 Audubon Street, Adair, IA 50002ComplianceApr 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Theodore R Liautaud DO5 organizations share this tax ID, including this one
Part of
Theodore R Liautaud DO

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Brandon G Johnson Individual Corporate OfficerCfo May 28, 2024
W-2 Managing EmployeeCfo May 28, 2024
Operational/Managerial ControlCfo May 28, 2024
Austin J Boeckman Individual W-2 Managing EmployeeMD; Jul 17, 2023
Operational/Managerial ControlMedical Director Jul 17, 2023
Central Iowa Hospital Corporation Organization, Des Moines, IA Corporation, Non-profit Operational/Managerial Control Jan 1, 2014
Doris M Terwilliger Individual Corporate Director Jan 3, 2023
Douglas I Kent Individual Corporate Officer Jan 1, 2023
Corporate Director Jan 2, 2021
Sheyrl a Clark Individual Corporate Director Jan 3, 2023
Dana L Tews Individual Corporate Officer Jan 1, 2023
Corporate Director Jan 25, 2021
Michael L Underwood Individual Corporate Officer Jan 1, 2018
Corporate Director Jan 3, 2017
Emily a Donovan Individual Corporate Director Jan 2, 2025
Tina M Nourse Individual W-2 Managing EmployeeAd;Chief Clinic Administrator Sep 5, 2013
Operational/Managerial ControlChief Clinic Administrator Sep 5, 2013
Christopher R Stipe Individual Contracted Managing EmployeeCeo Jul 31, 2023
Corporate OfficerCeo Jul 31, 2023
Operational/Managerial ControlCeo Jul 31, 2023
Cheryl L Marks Individual Corporate Officer Jan 1, 2021
Corporate Director Jul 20, 2020

Owners & managing parties with NPI records 7

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

Facilities with the same owner 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1224806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698192000000",
    "number": "1710130588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N 12TH ST",
            "city": "GUTHRIE CENTER",
            "state": "IA",
            "postal_code": "501151549",
            "telephone_number": "641-332-2201",
            "fax_number": "641-332-2702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 AUDUBON ST",
            "city": "ADAIR",
            "state": "IA",
            "postal_code": "500027708",
            "telephone_number": "641-742-1000",
            "fax_number": "641-742-3414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUTHRIE COUNTY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GUTHRIE COUNTY HOSPITAL",
        "enumeration_date": "2008-10-24",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A",
        "authorized_official_last_name": "STIPE",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "641-332-2201",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "28764",
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740265222",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lavonneh@gcho.securechart.com",
            "affiliation": "N",
            "endpointDescription": "Guthrie County Hospital",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "710 N 12th St",
            "city": "Guthrie Center",
            "state": "IA",
            "country_code": "US",
            "postal_code": "501151544",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "GCH CLINICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Adair, IA

Sources for this page

Verify at the official NPI Registry.