Virginia Gay Hospital, Inc
Organization Active NPI Rural Health Clinic/Center · Van Horne, IA
NPI 1821031436 · NPPES record last updated Sep 22, 2016
Key facts
- NPI
- 1821031436
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- VIRGINIA GAY HOSPITAL, INC
- Practice address
- 205 Main St
Van Horne, IA 52346-9713 - Phone
- (319) 228-8000
- NPI assigned
- Jun 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Michael J Riege
- Title
- Administrator
- Phone
- (319) 472-6200
Owners & managing parties with NPI records 2
-
Michelle Elgin, D.O.
-
Brian W Meeker, D.O.
Owned or controlled facilities with NPI records 3
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 9
Practitioners 19
-
Stephanie Nichole Becker, ARNP
-
Michele E Burnes, PA-C
-
Sarah A Eikenberry, MPT
-
Michelle Elgin, D.O.
-
Emily Ann Flexsenhar, ARNP
-
Michael J Foggia II, D.O.
-
Mariam Gallagher, DO
-
Samantha Isaac, PA
-
Samantha J Jirak, DNP
-
Pamela Keel, ARNP
-
Alison Lagrange, ARNP
-
Brendan Dean Leiran, PA-C
-
Tammy M Madsen, PA-C
-
Brian W Meeker, D.O.
-
Abigail Renee Reiter, PA-C
-
Matthew Wilden, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 16D0929583 | Van Horn Family Medical Clinic | Provider-performed microscopy | Aug 20, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Rural health clinic certification: CCN 163468
- Legal name
- VIRGINIA GAY HOSPITAL INC
- Doing business as
- VAN HORNE FAMILY MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- May 1, 1997
- Last certification
- May 26, 2022
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 1, 1976 in IA
- Enrollment address
- 205 Main Street
Van Horne, IA 52346-9713
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| John F. Yundt |
Corporate Officer |
Oct 20, 2009 | 11% |
| Corporate Director |
Nov 1, 2001 | 11% | |
| John Mossman |
Corporate Officer |
Jan 1, 2019 | |
| David Homer Vermedahl |
Corporate Officer |
Nov 1, 2004 | 11% |
| Corporate Director |
Nov 1, 2001 | 11% | |
| Kyle Koeppen |
Corporate Officer |
Oct 1, 2021 | |
| Tina M Eden |
Corporate Officer |
Apr 1, 2025 | |
| W-2 Managing Employee |
Apr 1, 2025 | ||
| Operational/Managerial Control |
Apr 1, 2025 | ||
| Sara S Stuefen |
Corporate Officer |
Jan 1, 2019 | |
| Corporate Director |
Jan 1, 2019 | 11% | |
| Max Maynard |
Corporate Director |
Jan 1, 2018 | 11% |
| Barry W Dietsch |
Corporate Officer |
Jul 8, 2014 | |
| W-2 Managing Employee |
Jul 8, 2014 | ||
| Operational/Managerial Control |
Jul 8, 2014 | ||
| Brian W Meeker |
Corporate Director |
Jun 19, 1995 | 11% |
| Michelle M Elgin |
Corporate Director |
Sep 17, 2013 | 11% |
| Marie T Foth |
Corporate Director |
Oct 20, 2009 | 11% |
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Virginia Gay Hospital Home Health |
Home health agency | Operational/Managerial Control (100%) | Dec 15, 1994 |
| Urbana Family Medical Clinic |
Rural health clinic | Operational/Managerial Control | Jun 15, 1992 |
| Atkins Family Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Aug 20, 2012 Aug 20, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090728000766 | IA | Part a Provider - Rural Health Clinic | 1759290331 | Practice locations: Van Horne, IA |
National Provider Directory
- Tax ID family
- Virginia Gay Hospital
Locations
1002 W Main St
Urbana, IA 52345
Phone (319) 443-5000
205 Main St
Van Horne, IA 52346
Phone (319) 228-8000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
205 Main St
Van Horne, IA 52346-9713
Mailing address
205 Main St
Van Horne, IA 52346-9713
Phone (319) 228-8000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0634683 | Medicaid | IA |
Other names
- Van Horne Family Medical Clinic
Other providers in Van Horne, IA
All providers in Van Horne, IA · Rural Health Clinic/Center in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.