NPIMap

Organization Active NPI

Stewart Memorial Community Hospital

  • Emergency Medicine Physician
  • Lake City, IA
National Provider Identifier
1740321652
Registry record updated Nov 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
STEWART MEMORIAL COMMUNITY HOSPITAL
Practice address
1301 W Main St
Lake City, IA 51449-1585
Phone
(712) 464-3171
Fax
(712) 464-3269
NPI assigned
Feb 12, 2007
Last updated
Nov 1, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
STEWART MEMORIAL COMMUNITY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 1, 2021

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

Authorized official

Name
James L Henkenius
Title
Cfo
Phone
(712) 464-4200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X
Emergency Medicine Physician 207P00000X Primary

Addresses

Primary practice location

1301 W Main St
Lake City, IA 51449-1585

Mailing address

1301 W Main St
Lake City, IA 51449-1585
Phone (712) 464-3171

Other identifiers 1

IdentifierTypeStateIssuer
0097428MedicaidIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031107000249 IA Part B Supplier - Clinic/Group Practice 4486563707 Receives reassigned benefits from 48 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lake City, IA

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Stewart Mem Community

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635724800000",
    "number": "1740321652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 W MAIN ST",
            "city": "LAKE CITY",
            "state": "IA",
            "postal_code": "514491585",
            "telephone_number": "712-464-3171",
            "fax_number": "712-464-3269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 W MAIN ST",
            "city": "LAKE CITY",
            "state": "IA",
            "postal_code": "514491585",
            "telephone_number": "712-464-3171",
            "fax_number": "712-464-3269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEWART MEMORIAL COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STEWART MEMORIAL COMMUNITY HOSPITAL",
        "enumeration_date": "2007-02-12",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A",
        "authorized_official_last_name": "HENKENIUS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "712-464-4200"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0097428",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.