NPIMap

Organization Active NPI

Sumner Community Club

Doing business as Community Memorial Hospital

  • Critical Access Hospital
  • Sumner, IA
National Provider Identifier
1780684548
Registry record updated Jul 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
090086H Issued in IA
Legal business name
SUMNER COMMUNITY CLUB
Doing business as
Community Memorial Hospital
Practice address
909 W 1St St
Sumner, IA 50674-1203
Phone
(563) 578-3275
Fax
(563) 578-3279
NPI assigned
Jul 22, 2005
Last updated
Jul 31, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2015

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

Authorized official

Name
Dawn Diane Everding, CFO
Title
Chief Financial Officer
Phone
(563) 578-3275

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 090086H IA Primary
Nurse Practitioner 363L00000X
Certified Registered Nurse Anesthetist 367500000X
Registered Dietitian 133V00000X
Emergency Medicine Physician 207P00000X
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

909 W 1St St
Sumner, IA 50674-1203

Mailing address

PO Box 148
Sumner, IA 50674-0148
Phone (563) 578-3275

Other identifiers 4

IdentifierTypeStateIssuer
0601385OtherIATITLE XIX
6230725OtherIAAETNA
60138OtherIABLUE CROSS (ACUTE)
A5067404OtherIAJOHN DEERE

Other names 1

  • Community Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061104000206 IA Part A Provider - Critical Access Hospital 5890607691 Receives reassigned benefits from 47 practitioners
Practice locations: Sumner, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780684548. Details of each certification follow.

Hospital certification: CCN 161320

Legal name
SUMNER COMMUNITY CLUB
Doing business as
COMMUNITY MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
May 1, 2001
Last certification
Sep 28, 2022
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
909 W 1St St
Sumner, IA 50674-1203
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Community Memorial Hospital Medical CenterCCN 161320 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Sumner Community Club2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

100 Bolger Dr
Fayette, IA 52142
Phone (563) 425-3336

905 W 1St St
Sumner, IA 50674
Phone (319) 578-3244

905W 1St St
Sumner, IA 50674
Phone (563) 578-5375

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
United States Department of Agriculture Organization, Waverly, IA 5% Or Greater Mortgage Interest Dec 1, 2013 48.9%
Mariah Kay Nuss Individual Corporate DirectorBoard Member Mar 19, 2024
Andrew K Baker Individual Corporate DirectorBoard Member Mar 17, 2020
Sheila R Uhlenhake Individual W-2 Managing EmployeeManager of Analytics/Credentialing May 21, 2018
Paul Bahe Individual Corporate DirectorChair BD Directors Mar 18, 2025
Angela Leete Individual Corporate DirectorVice Chair BD Directors Mar 15, 2016
Allen Health Systems Inc Organization, Waterloo, IA Corporation, Non-profit Operational/Managerial Control Jan 1, 2000
Elaine M Davis Individual Corporate DirectorSec/Treas BD Directors Mar 18, 2025
David Scott Individual Corporate DirectorMember Board of Directors Mar 20, 2018
Daniel K Weltner Individual Corporate DirectorBoard Member Mar 17, 2026
Kevin R Holtz Individual Corporate DirectorBoard Member Mar 21, 2023
Tyler Steven Rau Individual Corporate OfficerBoard Member Mar 18, 2025
Kari L Kelly Individual Corporate DirectorBoard Member Mar 17, 2026
Michele M Anderson Individual Corporate DirectorBoard Member Mar 21, 2023
Sandra Christensen Individual Corporate OfficerBoard Member Mar 18, 2025
Dawn Daine Everding Individual Corporate OfficerPresident/Chief Financial Officer May 21, 2018
W-2 Managing EmployeePresident/Chief Financial Officer May 21, 2018

Facilities with the same owner 12

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

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 53

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 53

Affiliated clinicians 71

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 71

NPI Registry JSON

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438300800000",
    "number": "1780684548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 148",
            "city": "SUMNER",
            "state": "IA",
            "postal_code": "506740148",
            "telephone_number": "563-578-3275",
            "fax_number": "563-578-3279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 W 1ST ST",
            "city": "SUMNER",
            "state": "IA",
            "postal_code": "506741203",
            "telephone_number": "563-578-3275",
            "fax_number": "563-578-3279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMNER COMMUNITY CLUB",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-22",
        "last_updated": "2015-07-31",
        "status": "A",
        "authorized_official_last_name": "EVERDING",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "563-578-3275",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IA",
            "license": "090086H",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TITLE XIX",
            "identifier": "0601385",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "6230725",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS (ACUTE)",
            "identifier": "60138",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "A5067404",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sumner, IA

Sources for this page

Verify at the official NPI Registry.