NPIMap

Organization Active NPI

Virginia Gay Hospital, Inc

Doing business as Van Horne Family Medical Clinic

  • Rural Health Clinic/Center
  • Van Horne, IA
National Provider Identifier
1821031436
Registry record updated Sep 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
VIRGINIA GAY HOSPITAL, INC
Doing business as
Van Horne Family Medical Clinic
Practice address
205 Main St
Van Horne, IA 52346-9713
Phone
(319) 228-8000
NPI assigned
Jun 13, 2006
Last updated
Sep 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2016

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

Authorized official

Name
Michael J Riege
Title
Administrator
Phone
(319) 472-6200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

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 1

IdentifierTypeStateIssuer
0634683MedicaidIA

Other names 1

  • Van Horne Family Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090728000766 IA Part A Provider - Rural Health Clinic 1759290331 Practice locations: Van Horne, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821031436. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Mar 1, 1976 in IA
Enrollment address
205 Main Street
Van Horne, IA 52346-9713

Other NPIs with the same Medicare PAC ID 6

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0929583Van Horn Family Medical Clinic205 Main Street, Van Horne, IA 52346Provider-performed microscopyAug 20, 2026

National Provider Directory

National Provider Directory
Tax ID family
Vinton Family Medical C10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

401 Cardinal Ave
Atkins, IA 52206
Phone (319) 446-6231

205 Main St
Van Horne, IA 52346
Phone (319) 228-8000

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
John F. Yundt Individual Corporate OfficerTreasurer Oct 20, 2009 11%
Corporate DirectorTreasurer Nov 1, 2001 11%
John Mossman Individual Corporate OfficerBoard Member Jan 1, 2019
David Homer Vermedahl Individual Corporate OfficerSecretary Nov 1, 2004 11%
Corporate DirectorSecretary Nov 1, 2001 11%
Kyle Koeppen Individual Corporate OfficerBoard Member Oct 1, 2021
Tina M Eden Individual Corporate OfficerCeo Apr 1, 2025
W-2 Managing EmployeeAd;Ceo Apr 1, 2025
Operational/Managerial ControlCeo Apr 1, 2025
Sara S Stuefen Individual Corporate OfficerSecretary Jan 1, 2019
Corporate DirectorSecretary Jan 1, 2019 11%
Max Maynard Individual Corporate DirectorBoard Member Jan 1, 2018 11%
Barry W Dietsch Individual Corporate OfficerCfo Jul 8, 2014
W-2 Managing EmployeeCfo Jul 8, 2014
Operational/Managerial ControlCfo Jul 8, 2014
Brian W Meeker Individual Corporate DirectorBoard Member Jun 19, 1995 11%
Michelle M Elgin Individual Corporate DirectorBoard Member Sep 17, 2013 11%
Marie T Foth Individual Corporate DirectorBoard Member Oct 20, 2009 11%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Virginia Gay Hospital Home HealthVinton, IA, CCN 167063 Home health agency Operational/Managerial Control (100%) Dec 15, 1994
Urbana Family Medical ClinicUrbana, IA, CCN 163485 Rural health clinic Operational/Managerial Control Jun 15, 1992
Atkins Family Medical ClinicAtkins, IA, CCN 168556 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 20, 2012
Aug 20, 2012

Owned or controlled facilities with NPI records 3

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

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474502400000",
    "number": "1821031436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 MAIN ST",
            "city": "VAN HORNE",
            "state": "IA",
            "postal_code": "523469713",
            "telephone_number": "319-228-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 MAIN ST",
            "city": "VAN HORNE",
            "state": "IA",
            "postal_code": "523469713",
            "telephone_number": "319-228-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRGINIA GAY HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2016-09-22",
        "status": "A",
        "authorized_official_last_name": "RIEGE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "319-472-6200"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0634683",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Van Horne Family Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Van Horne, IA

Sources for this page

Verify at the official NPI Registry.