NPIMap

Organization Active NPI

Infinity Health

  • Federally Qualified Health Center (FQHC)
  • Leon, IA
National Provider Identifier
1770521981
Registry record updated Feb 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
INFINITY HEALTH
Practice address
302 NE 14TH St
Leon, IA 50144-1206
Phone
(641) 446-2383
Fax
(641) 446-2383
NPI assigned
Jun 2, 2006
Last updated
Feb 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2022

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

Authorized official

Name
Ms. Samantha Cannon
Title
Ceo
Phone
(641) 446-2383

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

302 NE 14TH St
Leon, IA 50144-1206

Mailing address

302 NE 14TH St
Leon, IA 50144-1206
Phone (641) 446-2383

Other identifiers 4

IdentifierTypeStateIssuer
0462887MedicaidIA
39014OtherWELLMARK BLUE CROSS/ BLUE SHIELD
61826OtherWELLMARK MEDICARE BLUE PPO
507202208MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, MO7 enrollments

Enrollment records 7

Enrollment IDStateProvider typePAC IDDetails
O20051024000374 IA Part B Supplier - Clinic/Group Practice 5597717496 Receives reassigned benefits from 27 practitioners
9 other NPIs on this enrollment
Practice locations: Albia, IA; Centerville, IA; Chariton, IA; Corydon, IA; Knoxville, IA; Lamoni, IA; Leon, IA; Mount Ayr, IA…
O20061012000688 IA Part A Provider - Federally Qualified Health Center (FQHC) 5597717496 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Corydon, IA
O20061012000691 IA Part A Provider - Federally Qualified Health Center (FQHC) 5597717496 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Albia, IA
O20061204000315 IA Part A Provider - Federally Qualified Health Center (FQHC) 5597717496 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Centerville, IA
O20070126000685 IA Part A Provider - Federally Qualified Health Center (FQHC) 5597717496 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chariton, IA
O20101109000913 IA Part A Provider - Federally Qualified Health Center (FQHC) 5597717496 Practice locations: Leon, IA
O20200601000739 MO Part B Supplier - Clinic/Group Practice 5597717496 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
Practice locations: Princeton, MO

NPI to CCN mapping 5

The Medicare certification numbers (CCNs) connected to NPI 1770521981. Details of each certification follow.

Federally qualified health center certification: CCN 161839

Legal name
INFINITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 6, 2006
Last certification
Dec 6, 2006
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 2005 in IA
Enrollment address
102 N Franklin St
Corydon, IA 50060-1405

Federally qualified health center certification: CCN 161838

Legal name
INFINITY HEALTH
Doing business as
BEHAVIORAL HEALTH CENTERS OF SOUTHERN IOWA ALBIA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 6, 2006
Last certification
Dec 6, 2006
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 2005 in IA
Enrollment address
117 S Main St
Albia, IA 52531-2013

Federally qualified health center certification: CCN 161840

Legal name
INFINITY HEALTH
Doing business as
BEHAVIORAL HEALTH CENTERS OF SOUTHERN IOWA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 6, 2006
Last certification
Dec 6, 2006
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 2005 in IA
Enrollment address
221E State St
Centerville, IA 52544-1813

Federally qualified health center certification: CCN 161841

Legal name
INFINITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 13, 2007
Last certification
Apr 13, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 2005 in IA
Enrollment address
1711 Osceola Ave
Ste 115
Chariton, IA 50049-1516

Federally qualified health center certification: CCN 161826

Legal name
INFINITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 27, 2005
Last certification
May 27, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 2005 in IA
Enrollment address
302 NE 14TH St
Leon, IA 50144-1206

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory

Locations

117 S Main St
Albia, IA 52531
Phone (641) 932-2065

102 N Franklin St
#104
Corydon, IA 50060
Phone (641) 872-1750

131 W Washington St
Osceola, IA 50213
Phone (641) 342-9000

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Brenda Fry Individual Corporate DirectorBoard Member Mar 1, 2022 11.11%
Shirley Kessel Individual Corporate DirectorBoard Chair Jan 1, 2005 11.11%
Corporate DirectorBoard Chair Jan 1, 2005 10%
Pamela Burlin Individual Corporate DirectorBoard Member Nov 30, 2021 11.11%
Corporate DirectorBoard Member Nov 30, 2021
William Weaver Individual Corporate DirectorBoard Member Apr 26, 2022 11.11%
Alan Wilson Individual Corporate Director Mar 23, 2010 11.11%
Corporate Director Mar 23, 2010 10%
Corporate DirectorAt-Large-Member Mar 23, 2010 10%
William Morain Individual Corporate DirectorBoard Secretary Jan 1, 2005 11.11%
Corporate DirectorBoard Secretary Jan 1, 2005 10%
Samantha Cannon Individual Corporate OfficerCeo Nov 27, 2012
Corporate DirectorCeo Nov 27, 2012
W-2 Managing EmployeeCeo Nov 27, 2012
Dien Judge Individual Corporate Director Oct 28, 2014 11.11%
Corporate DirectorBoard Member Oct 28, 2014 10%
Corporate Director Oct 28, 2014 10%
Corporate DirectorVice Chairperson Oct 28, 2014 10%
Marvin McCann Individual Corporate DirectorBoard Chair Apr 27, 2021 11.11%
Corporate DirectorBoard Member Apr 27, 2021
Justin James Akers Individual Corporate DirectorBoard Treasurer Aug 22, 2017 10%
Rachel Cecil Individual Corporate Director Mar 26, 2019 10%
Jonathan Erb Individual Corporate Director Sep 24, 2019 10%
Marcy Biesemeyer Individual Corporate DirectorBoard Member Apr 22, 2014 10%
Corporate Director Apr 22, 2014 10%
Linda Baynes Individual Corporate DirectorVice Chair May 22, 2018 10%
Alan Dykens Individual Corporate Director Jan 24, 2017 10%
Corporate DirectorBoard Member Jan 24, 2017 10%

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644537600000",
    "number": "1770521981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 NE 14TH ST",
            "city": "LEON",
            "state": "IA",
            "postal_code": "501441206",
            "telephone_number": "641-446-2383",
            "fax_number": "641-446-2382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 NE 14TH ST",
            "city": "LEON",
            "state": "IA",
            "postal_code": "501441206",
            "telephone_number": "641-446-2383",
            "fax_number": "641-446-2383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFINITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2022-02-11",
        "certification_date": "2022-02-11",
        "status": "A",
        "authorized_official_last_name": "CANNON",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "641-446-2383",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0462887",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BLUE CROSS/ BLUE SHIELD",
            "identifier": "39014",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK MEDICARE BLUE PPO",
            "identifier": "61826",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507202208",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leon, IA

Sources for this page

Verify at the official NPI Registry.