NPIMap

Organization Active NPI

Hawarden Regional Healthcare

  • Medicare Defined Swing Bed Hospital Unit
  • Hawarden, IA
National Provider Identifier
1790740884
Registry record updated Nov 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
HAWARDEN REGIONAL HEALTHCARE
Practice address
1111 11TH St
Hawarden, IA 51023-1903
Phone
(712) 551-3112
Fax
(712) 551-3195
NPI assigned
Apr 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2022

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

Authorized official

Name
Mr. Jayson P Pullman
Title
Ceo
Phone
(712) 551-3103

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary
Critical Access Hospital 282NC0060X 840126H IA

Addresses

Primary practice location

1111 11TH St
Hawarden, IA 51023-1903

Mailing address

1111 11TH St
Hawarden, IA 51023-1903
Phone (712) 551-3112

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081002000167 IA Part A Provider - Critical Access Hospital 0547257990 Practice locations: Hawarden, IA

Hospital certification: CCN 16Z311

Legal name
HAWARDEN REGIONAL HEALTHCARE
Doing business as
HAWARDEN REGIONAL HEALTHCARE
Organization structure
GovernmentNon-profit
Enrollment address
1111 11TH St
Hawarden, IA 51023-1903
Other Hospital Practice 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).

National Provider Directory

National Provider Directory
Tax ID family
Community Hosp4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Israel Curiel Individual Corporate Director Feb 28, 2019
Amy L Cravaack Individual W-2 Managing EmployeeDirector of Finance Apr 25, 2022
Operational/Managerial ControlDirector of Finance Apr 25, 2022
Stanley Hoekstra Individual Corporate Officer Jan 23, 2020
Corporate Director Oct 24, 2007
Mercy Health Network Inc Organization, Clive, IA Corporation, Management services company, Non-profit Operational/Managerial Control Aug 1, 2016
Matthew Hummel Individual Corporate Officer Feb 1, 2006
Corporate Director Jan 27, 2000
Emma L Bouza Individual Corporate Director Jan 23, 2020
Dennis M Hulshof Individual Corporate Officer Feb 4, 2016
Corporate Director Jan 27, 2010
Jayson P Pullman Individual Contracted Managing EmployeeCeo Oct 5, 2011
Corporate OfficerCeo Mar 31, 2020
Operational/Managerial ControlCeo Oct 5, 2011

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hawarden ClinicHawarden, IA, CCN 168503 Rural health clinic 5% Or Greater Direct Ownership Interest (50%)
Operational/Managerial Control		 Aug 3, 2004
Aug 3, 2004

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 98

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

View all 98

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669680000000",
    "number": "1790740884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 11TH ST",
            "city": "HAWARDEN",
            "state": "IA",
            "postal_code": "510231903",
            "telephone_number": "712-551-3112",
            "fax_number": "712-551-3195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 11TH ST",
            "city": "HAWARDEN",
            "state": "IA",
            "postal_code": "510231903",
            "telephone_number": "712-551-3112",
            "fax_number": "712-551-3195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAWARDEN REGIONAL HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A",
        "authorized_official_last_name": "PULLMAN",
        "authorized_official_first_name": "JAYSON",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-551-3103",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IA",
            "license": "840126H",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hawarden, IA

Sources for this page

Verify at the official NPI Registry.